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General NPI Number Information
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NPI Number | 1821417833
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Entity Type | Individual
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Provider Name | CORY A VAUGHN MD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2014
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 6823 ISAACS ORCHARD RD
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City | SPRINGDALE
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State | AR
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Zip | 72762-6096
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Country | US
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Telephone | 479-750-2080
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Fax | 479-750-2082
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Provider Business Mailing Address
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Address Line | 6823 ISAACS ORCHARD RD
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City | SPRINGDALE
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State | AR
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Zip | 72762-6096
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Country | US
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Telephone | 479-750-2080
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Fax | 479-750-2082
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | E12021
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License Number State | AR
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