Provider Demographics
NPI:1598758716
Name:VAUGHAN, RODERICK ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:ANDREW
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 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-243-8183
Mailing Address - Fax:
Practice Address - Street 1:1800 MEDICAL CENTER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2566
Practice Address - Country:US
Practice Address - Phone:615-896-6800
Practice Address - Fax:615-895-8890
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD24047207X00000X
TN24047207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ018433Medicaid
TN3801729Medicare ID - Type Unspecified
TN3801729Medicaid
TN0406260003Medicare NSC