Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036.130646 | IL |
NPI | 1487834958 |
---|---|
Provider Name | Dr. Ryan C Vaughn |
First Address | Schaumburg, IL 60173-4714 |
Second Address | Schaumburg, IL 60173-4714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2007 |
Last Update Date | 12/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036.130646 | IL STATE LICENSE NUMBER (01) | IL |