Provider Demographics
NPI:1568430999
Name:VAUGHN, JAMES DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DANIEL
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 1:216 W 10TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6304
Mailing Address - Country:US
Mailing Address - Phone:509-628-1220
Mailing Address - Fax:509-628-1354
Practice Address - Street 1:216 W 10TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6304
Practice Address - Country:US
Practice Address - Phone:509-221-5520
Practice Address - Fax:509-221-5521
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1107135Medicaid
WAF91662Medicare UPIN
WA1107135Medicaid