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General NPI Number Information
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NPI Number | 1437531829
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Entity Type | Organization
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Legal Business Name | VAUGHN BLACKBURN DPM LLC
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 5 W MAIN ST
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City | AMELIA
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State | OH
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Zip | 45102-1924
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Country | US
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Telephone | 513-753-0500
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Fax | 513-986-0218
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Provider Business Mailing Address
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Address Line | 6200 PLEASANT AVE STE 3
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City | FAIRFIELD
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State | OH
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Zip | 45014-4670
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Country | US
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Telephone | 513-829-9333
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Fax | 513-858-7827
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Authorized Official
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Title or Position | DPM
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Name | VAUGHN DANIEL BLACKBURN
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Credential |
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Telephone | 513-753-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36003708
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License Number State | OH
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