Provider Demographics
NPI:1942349659
Name:BEGICK, VAUGHN JERRY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:VAUGHN
Middle Name:JERRY
Last Name:BEGICK
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5353 LORRAINE CT
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-686-0578
Mailing Address - Fax:989-895-4860
Practice Address - Street 1:1458 W CENTER RD
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-2151
Practice Address - Country:US
Practice Address - Phone:989-895-4860
Practice Address - Fax:989-895-4870
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001016363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S81035Medicare UPIN
MIP43930011Medicare PIN
N90070002Medicare ID - Type Unspecified
MI0P43930Medicare PIN