Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 48015 | TN |
NPI | 1588645774 |
---|---|
Provider Name | William Glaze Vaughan |
First Address | Knoxville, TN 37901-5004 |
Second Address | Knoxville, TN 37916-2290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 24/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1527042 | (05) | TN |
8F23624 | (02) | TX |