Provider Demographics
NPI:1649505033
Name:VAUGHN, DAVID WILLIAM
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:VAUGHN
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 1:1564 S 2900 W
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:ID
Mailing Address - Zip Code:83210-1606
Mailing Address - Country:US
Mailing Address - Phone:208-397-3147
Mailing Address - Fax:
Practice Address - Street 1:1564 S 2900 W
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:ID
Practice Address - Zip Code:83210-1606
Practice Address - Country:US
Practice Address - Phone:208-397-3147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management