MEDICARE: DR. DUSTIN L. VAUGHAN MSOM, DIPL. O.M., AP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AP4214	FL

General Provider Information

NPI Number	:	1265021554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN L. VAUGHAN MSOM, DIPL. O.M., AP

Provider Business Mailing Address
First Line	:	877 W MINNEOLA AVE UNIT 121262
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34712-7052
Country	:	US
Telephone Number	:	352-901-4513
Fax Number	:	352-404-7640

Provider Business Practice Location Address
First Line	:	835 7TH ST UNIT 1
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-2190
Country	:	US
Telephone Number	:	352-901-4513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	02/23/2021

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