Healthcare Provider Details

I. General information

NPI: 1588668339
Provider Name (Legal Business Name): VAUGHN M ESKEW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 HOLT ST
ASHLAND KY
41105-4069
US

IV. Provider business mailing address

PO BOX 4069 2924 HOLT STREET
ASHLAND KY
41105-4069
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-7181
  • Fax: 606-324-5423
Mailing address:
  • Phone: 606-329-9444
  • Fax: 606-324-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23974
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23974
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: