Provider Demographics
NPI:1588668339
Name:ESKEW, VAUGHN M (MD)
Entity Type:Individual
Prefix:MR
First Name:VAUGHN
Middle Name:M
Last Name:ESKEW
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 4069
Mailing Address - Street 2:2924 HOLT STREET
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-4069
Mailing Address - Country:US
Mailing Address - Phone:606-329-9444
Mailing Address - Fax:606-324-5423
Practice Address - Street 1:2916 HOLT ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41105-4069
Practice Address - Country:US
Practice Address - Phone:606-324-7181
Practice Address - Fax:606-324-5423
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23974207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00176940OtherMEDICARE RAIL ROAD PIN
KYP00176940OtherMEDICARE RAIL ROAD PIN
KYA80880Medicare UPIN