Provider Demographics
NPI:1548376304
Name:PAUL L VAUGHN ASSOCIATES LLC
Entity type:Organization
Organization Name:PAUL L VAUGHN ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-491-4101
Mailing Address - Street 1:2204 S DOBSON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6457
Mailing Address - Country:US
Mailing Address - Phone:480-491-4101
Mailing Address - Fax:480-491-4102
Practice Address - Street 1:2204 S DOBSON RD STE 204
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6457
Practice Address - Country:US
Practice Address - Phone:480-491-4101
Practice Address - Fax:480-491-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241442471V0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional TechnologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ390948Medicaid
AZG29330Medicare UPIN
AZ390948Medicaid