Provider Demographics
NPI:1932146354
Name:JEFFERSON R VAUGHAN MD FACS PC
Entity Type:Organization
Organization Name:JEFFERSON R VAUGHAN MD FACS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:R
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-838-3520
Mailing Address - Street 1:48 MEDICAL PARK DR E
Mailing Address - Street 2:STE 150
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3400
Mailing Address - Country:US
Mailing Address - Phone:205-838-3520
Mailing Address - Fax:205-838-3124
Practice Address - Street 1:48 MEDICAL PARK DR E
Practice Address - Street 2:STE 150
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3400
Practice Address - Country:US
Practice Address - Phone:205-838-3520
Practice Address - Fax:205-838-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26990208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherEIN