Provider Demographics
NPI:1053316257
Name:VAUGHAN, SUZANNE D (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:D
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 INTRACOASTAL POINTE DR
Mailing Address - Street 2:STE 300
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5024
Mailing Address - Country:US
Mailing Address - Phone:561-744-9122
Mailing Address - Fax:
Practice Address - Street 1:7500 HUGH DANIEL DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-7148
Practice Address - Country:US
Practice Address - Phone:561-744-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.128442085R0202X
AL12844174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555272Medicare PIN
E55193Medicare UPIN