Healthcare Provider Details

I. General information

NPI: 1821417833
Provider Name (Legal Business Name): CORY A VAUGHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6823 ISAACS ORCHARD RD
SPRINGDALE AR
72762-6096
US

IV. Provider business mailing address

6823 ISAACS ORCHARD RD
SPRINGDALE AR
72762-6096
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-2080
  • Fax: 479-750-2082
Mailing address:
  • Phone: 479-750-2080
  • Fax: 479-750-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberE12021
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: