Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 231349 | MA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 5037 | AZ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 5037 | AZ |
NPI | 1578753612 |
---|---|
Provider Name | Jeffrey M Vaughn |
First Address | Phoenix, AZ 85016-7710 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 11/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
373223 | (05) | AZ |