Healthcare Provider Details

I. General information

NPI: 1376244061
Provider Name (Legal Business Name): CHRISTOPHER VAUGHAN, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W MYRTLE ST
BOISE ID
83702-7656
US

IV. Provider business mailing address

301 W MYRTLE ST
BOISE ID
83702-7656
US

V. Phone/Fax

Practice location:
  • Phone: 208-342-8202
  • Fax: 208-342-8202
Mailing address:
  • Phone: 208-342-8202
  • Fax: 208-342-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VANESSA RODRIGUEZ
Title or Position: PRACTICE MANAGER
Credential: RN
Phone: 208-342-8200