Provider Demographics
NPI:1164573531
Name:VAUGHN, CHARLES H (DPM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 FAIRMOUNT DRIVE
Mailing Address - Street 2:BLDG 2, UNIT 207
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247
Mailing Address - Country:US
Mailing Address - Phone:303-370-2271
Mailing Address - Fax:303-830-0545
Practice Address - Street 1:8335 FAIRMOUNT DRIVE
Practice Address - Street 2:BLDG 2, UNIT 207
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247
Practice Address - Country:US
Practice Address - Phone:303-370-2271
Practice Address - Fax:303-830-0545
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO435213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01004357Medicaid
COT89410Medicare UPIN
CO01004357Medicaid