Provider Demographics
NPI:1366822926
Name:VAUGHAN, CHRISTOPHER TROTTER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TROTTER
Last Name:VAUGHAN
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 1:301 W MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-7656
Mailing Address - Country:US
Mailing Address - Phone:208-342-8200
Mailing Address - Fax:208-342-8202
Practice Address - Street 1:301 W MYRTLE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7656
Practice Address - Country:US
Practice Address - Phone:208-342-8200
Practice Address - Fax:208-342-8202
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBP10053072207L00000X
IDM15294207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology