Doctor Name: | ZACHARY VAUGH |
NPI Number: | 1053706556 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP |
License Number: | AG1214019 |
Business Practice Address: | 24 Southtowne Dr Potosi, MO - 636645729 |
Business Phone Number: | 5734383733 |
Business Fax Number: | |
Mailing Address: | 24 Southtowne Dr, POTOSI |
State: | MO |
Postal Code: | 636645729 |
Phone Number: | 5734383733 |
Fax Number: | |
NPI Enumeration Date: | 04/01/2015 |
NPI Last Update Date: | 04/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AG1214019 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |