Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 12007 | SC |
NPI | 1184757288 |
---|---|
Provider Name | Dr. Ted R Vaughn |
First Address | Greenwood, SC 29646-4009 |
Second Address | Greenwood, SC 29646-4009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 13/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120078 | (05) | SC |
C68898 | (02) | SC |