Provider Demographics
NPI:1568401693
Name:VAUGHTERS, RAY B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:B
Last Name:VAUGHTERS
Suffix:JR
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:PO BOX 2454
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29802-2454
Mailing Address - Country:US
Mailing Address - Phone:803-649-2501
Mailing Address - Fax:803-641-6651
Practice Address - Street 1:39 VARDEN DR
Practice Address - Street 2:D
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5202
Practice Address - Country:US
Practice Address - Phone:803-649-2501
Practice Address - Fax:803-641-6651
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC06286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC06286Medicaid
SC06286Medicaid