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General NPI Number Information
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NPI Number | 1326016056
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Entity Type | Organization
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Legal Business Name | BADGER MOUNTAIN FAMILY MEDICINE PC
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 560 GAGE BLVD SUITE 206
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City | RICHLAND
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State | WA
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Zip | 99352-8650
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Country | US
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Telephone | 509-628-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 560 GAGE BLVD SUITE 206
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City | RICHLAND
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State | WA
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Zip | 99352-8650
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Country | US
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Telephone | 509-628-1220
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES DANIEL VAUGHN
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Credential | M.D.
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Telephone | 509-628-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00035663
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License Number State | WA
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