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General NPI Number Information
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NPI Number | 1346154382
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Entity Type | Individual
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Provider Name | EZRA VAUGHT
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Gender | Male
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | BUILDING 26012, CAROLINES AVENUE ANDERSEN AFB
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City | YIGO
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State | GU
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Zip | 96929
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Country | US
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Telephone | 671-366-2772
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Fax |
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Provider Business Mailing Address
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Address Line | BUILDING 26012, CAROLINES AVENUE ANDERSEN AFB
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City | YIGO
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State | GU
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Zip | 96929
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Country | US
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Telephone | 671-366-2772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State | GU
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