Provider Demographics
NPI:1588645774
Name:VAUGHAN, WILLIAM GLAZE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GLAZE
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:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:2100 CLINCH AVE STE 510
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2225
Practice Address - Country:US
Practice Address - Phone:865-546-2131
Practice Address - Fax:877-821-0891
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN480152086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527042Medicaid
TX0134405OtherUNITED HEALTH PLAN
TX153410009OtherPACIFICARE
TX124963305Medicaid
TN1527042Medicaid
TX5052038OtherAETNA
TX6478359003OtherCIGNA
TX820907OtherBLUE CROSS
TX124400OtherSUPERIOR CHIP
TX124963303Medicaid
TN4321281OtherBCBS
TX10028086OtherAMERIGROUP
TX124963306OtherCSHCN
TX303042OtherPHCS
TX303462OtherONE HEALTH PLAN
TX124963305Medicaid