Provider Demographics
NPI:1912904509
Name:VAUGHN, CECIL CYRUS III (MD)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:CYRUS
Last Name:VAUGHN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 W THUNDERBIRD RD
Mailing Address - Street 2:G-116
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3709
Mailing Address - Country:US
Mailing Address - Phone:623-435-1954
Mailing Address - Fax:623-435-1955
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:G-116
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3709
Practice Address - Country:US
Practice Address - Phone:623-435-1954
Practice Address - Fax:623-435-1955
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ224942086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E21702Medicare UPIN
AZ62188Medicare ID - Type Unspecified