Provider Demographics
NPI:1245244961
Name:VAUGHT, JEFFERY D (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:D
Last Name:VAUGHT
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 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-890-2000
Mailing Address - Fax:317-859-4269
Practice Address - Street 1:679 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1049
Practice Address - Country:US
Practice Address - Phone:317-859-7222
Practice Address - Fax:317-859-7220
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043396A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091685OtherANTHEM PROVIDER NUMBER
IN200028680Medicaid
IN000000091685OtherANTHEM PROVIDER NUMBER
IN1487680518OtherGROUP NPI NUMBER
IN340012526OtherMEDICARE RAILROAD
IN340012491OtherMEDICARE RAILROAD
IN340012512OtherMEDICARE RAILROAD
IN100194370OtherMEDICAID GROUP NUMBER
IN896480JMedicare PIN
IN1487680518OtherGROUP NPI NUMBER
IN340012512OtherMEDICARE RAILROAD
IN677730LMedicare PIN
IN145840AMedicare PIN