Healthcare Provider Details

I. General information

NPI: 1275686305
Provider Name (Legal Business Name): HADRYAN H VAUGHN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 WOODMERE BLVD
MONTGOMERY AL
36106-3078
US

IV. Provider business mailing address

4709 WOODMERE BLVD
MONTGOMERY AL
36106-3078
US

V. Phone/Fax

Practice location:
  • Phone: 334-277-3338
  • Fax: 334-277-3357
Mailing address:
  • Phone: 334-277-3338
  • Fax: 334-277-3357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number213
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number213
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: