MEDICARE: WILLIAM GLAZE VAUGHAN MD

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	2086S0120X	Pediatric Surgery Physician	48015	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588645774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM GLAZE VAUGHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 15004
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37901-5004
Country	:	US
Telephone Number	:	865-541-8895
Fax Number	:	865-633-4808

Provider Business Practice Location Address
First Line	:	2100 CLINCH AVE STE 510
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37916-2225
Country	:	US
Telephone Number	:	865-546-2131
Fax Number	:	877-821-0891

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	04/08/2022

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