Provider Demographics
NPI:1497001044
Name:VOUGHT, PAUL K (IDMT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:VOUGHT
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9223 RAINBOW SPRINGS CT APT 5
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2249
Mailing Address - Country:US
Mailing Address - Phone:502-386-3504
Mailing Address - Fax:
Practice Address - Street 1:9223 RAINBOW SPRINGS CT APT 5
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2249
Practice Address - Country:US
Practice Address - Phone:502-386-3504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians