Provider Demographics
NPI:1124215363
Name:JEFFERSON R VAUGHAN MD PA
Entity Type:Organization
Organization Name:JEFFERSON R VAUGHAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-741-5695
Mailing Address - Street 1:PO BOX 7532
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-7532
Mailing Address - Country:US
Mailing Address - Phone:561-741-5695
Mailing Address - Fax:561-741-5697
Practice Address - Street 1:1002 S OLD DIXIE HWY
Practice Address - Street 2:STE 203
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7202
Practice Address - Country:US
Practice Address - Phone:561-741-5695
Practice Address - Fax:561-741-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG03497Medicare UPIN