Provider Demographics
NPI:1477948917
Name:VAUGHN, MARK (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:6100 MINTON RD NW STE 101
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1900
Mailing Address - Country:US
Mailing Address - Phone:321-802-4075
Mailing Address - Fax:321-802-4074
Practice Address - Street 1:6100 MINTON RD NW STE 101
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1900
Practice Address - Country:US
Practice Address - Phone:321-802-4075
Practice Address - Fax:321-802-4074
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2024-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3992213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery