Provider Demographics
NPI:1801860044
Name:VAUGHN, GLENN CURRY (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:CURRY
Last Name:VAUGHN
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 1:10080 BALAYE RUN DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7902
Mailing Address - Country:US
Mailing Address - Phone:813-490-6100
Mailing Address - Fax:
Practice Address - Street 1:10080 BALAYE RUN DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7902
Practice Address - Country:US
Practice Address - Phone:813-490-6100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50923207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE58380Medicare UPIN
FL10350XMedicare ID - Type Unspecified
FL74845Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER