Basic Information
| Provider Information | |||||||||
| NPI: | 1104873025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEEGAN | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7679 | ||||||||
| Address2: | |||||||||
| City: | CAVE CREEK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853277679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805180411 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 650 E INDIAN SCHOOL RD | ||||||||
| Address2: | GOLD CLINIC | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD20333 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.