Provider Demographics
NPI:1801891197
Name:DEGAN, TERENCE (MD)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:
Last Name:DEGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1216 SUNCAST LN
Mailing Address - Street 2:STE 1
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9668
Mailing Address - Country:US
Mailing Address - Phone:916-933-5028
Mailing Address - Fax:916-933-8747
Practice Address - Street 1:1216 SUNCAST LN
Practice Address - Street 2:STE 1
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9668
Practice Address - Country:US
Practice Address - Phone:916-933-5028
Practice Address - Fax:916-933-8747
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2013-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG54148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2287735Medicaid
00G541480Medicare ID - Type Unspecified
CA2287735Medicaid