Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A67399 | CA |
NPI | 1053303461 |
---|---|
Provider Name | Mr. Mark A Vaughan |
First Address | Auburn, CA 95602-2412 |
Second Address | Auburn, CA 95602-2412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 02/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G96862 | (02) | CA |