Provider Demographics
NPI:1336607993
Name:VAUGHAN, BRENT E
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:E
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6244 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTA
Mailing Address - State:VA
Mailing Address - Zip Code:23821-2223
Mailing Address - Country:US
Mailing Address - Phone:434-774-4747
Mailing Address - Fax:
Practice Address - Street 1:6244 FLAT ROCK RD
Practice Address - Street 2:
Practice Address - City:ALBERTA
Practice Address - State:VA
Practice Address - Zip Code:23821-2223
Practice Address - Country:US
Practice Address - Phone:434-774-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)