Provider Demographics
NPI:1720419138
Name:VAUGHN, GEORGE M (CO, LO)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:CO, LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 VICTORY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2859
Mailing Address - Country:US
Mailing Address - Phone:513-751-6722
Mailing Address - Fax:513-861-6722
Practice Address - Street 1:2368 VICTORY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2859
Practice Address - Country:US
Practice Address - Phone:513-751-6722
Practice Address - Fax:513-861-6722
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1912324534OtherOPCC NPI
OH1912324534OtherOPCC NPI