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NPI Code Detail

MEDICARE: VICTOR LESLIE VAUGHN JR.

MEDICARE: VICTOR LESLIE VAUGHN JR.
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
1175T00000XPeer Specialist0002286OH

General Provider Information

NPI Number : 1548823768
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTOR LESLIE VAUGHN JR.
Provider Business Mailing Address
First Line : 11841 LAKE AVE APT 18
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-1802
Country : US
Telephone Number : 440-454-4379
Fax Number :
Provider Business Practice Location Address
First Line : 3214 PROSPECT AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2614
Country : US
Telephone Number : 216-910-9015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2019
Last Update Date : 10/30/2025

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