Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2012-00747 | NC |
Y | 207QS0010X | Family Doctor - Sports Medicine | 2012-00747 | NC |
NPI | 1205070703 |
---|---|
Provider Name | Aaron James Vaughan |
First Address | Eugene, OR 97403-2868 |
Second Address | Eugene, OR 97403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2009 |
Last Update Date | 01/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1205070703 | (05) | NC |