Provider Demographics
NPI:1336111798
Name:VAUGHN, PAUL L (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:VAUGHN
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 1:1940 N ALMA SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2841
Mailing Address - Country:US
Mailing Address - Phone:480-890-0280
Mailing Address - Fax:480-890-2047
Practice Address - Street 1:1940 N ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2841
Practice Address - Country:US
Practice Address - Phone:480-890-0280
Practice Address - Fax:480-890-2047
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241442086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ390948Medicaid
AZZ75878Medicare PIN
AZG29330Medicare UPIN