Provider Demographics
NPI:1760544142
Name:VAUGHN, LISA DAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DAWN
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3140 LINCOLN WAY E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3700
Mailing Address - Country:US
Mailing Address - Phone:330-832-3127
Mailing Address - Fax:330-832-1267
Practice Address - Street 1:3140 LINCOLN WAY E
Practice Address - Street 2:SUITE 201
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3700
Practice Address - Country:US
Practice Address - Phone:330-832-3127
Practice Address - Fax:330-832-1267
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2013-05-30
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Provider Licenses
StateLicense IDTaxonomies
OH34004806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE92261Medicare UPIN