Provider Demographics
NPI:1467618850
Name:VAUGHN, KYLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4611 E SHEA BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4254
Mailing Address - Country:US
Mailing Address - Phone:480-705-9920
Mailing Address - Fax:888-872-0466
Practice Address - Street 1:4611 E SHEA BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4254
Practice Address - Country:US
Practice Address - Phone:480-705-9920
Practice Address - Fax:888-872-0466
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0726213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
6716310001Medicare NSC
Z91973Medicare PIN