Provider Demographics
NPI:1134449291
Name:VAUGHAN, KRISTOS NEKTARIOS (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTOS
Middle Name:NEKTARIOS
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 MEDICAL PLAZA LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461
Mailing Address - Country:US
Mailing Address - Phone:910-454-1234
Mailing Address - Fax:910-253-4934
Practice Address - Street 1:3009 MEDICAL PLAZA LANE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461
Practice Address - Country:US
Practice Address - Phone:910-454-1234
Practice Address - Fax:910-253-4934
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine