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General NPI Number Information
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NPI Number | 1649677667
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Entity Type | Individual
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Provider Name | ZEKE NATHANIEL VOUGHT CSFA
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Gender | Male
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 1 HOSPITAL ROAD
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City | OAK BLUFFS
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State | MA
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Zip | 02557
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Country | US
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Telephone | 508-957-0193
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 209
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City | OAK BLUFFS
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State | MA
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Zip | 02557-0209
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Country | US
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Telephone | 508-687-9271
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 155169
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License Number State | MA
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