Provider Demographics
NPI:1053303461
Name:VAUGHAN, MARK A (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3256 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2412
Mailing Address - Country:US
Mailing Address - Phone:530-886-8630
Mailing Address - Fax:530-886-8629
Practice Address - Street 1:3256 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2412
Practice Address - Country:US
Practice Address - Phone:530-886-8630
Practice Address - Fax:530-886-8629
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67399208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG96862Medicare UPIN