Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 135833 | NY |
NPI | 1063650042 |
---|---|
Provider Name | Dr. James Edward Vaughan |
First Address | Elmira, NY 14905-1721 |
Second Address | Elmira, NY 14905-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 28/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
135833 | STATE MEDICAL LICENSE (01) | NY |