Healthcare Provider Details

I. General information

NPI: 1780666537
Provider Name (Legal Business Name): RICHARD SIDNEY VAUGHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 MARINERS DR
ROPER NC
27970-9014
US

IV. Provider business mailing address

401 MOYE BLVD
GREENVILLE NC
27834-3777
US

V. Phone/Fax

Practice location:
  • Phone: 309-531-9933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20691
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20691
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: