MEDICARE: SUZANNE D VAUGHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD.12844	AL
2	174400000X	Specialist	12844	AL

General Provider Information

NPI Number	:	1053316257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE D VAUGHAN MD

Provider Business Mailing Address
First Line	:	116 INTRACOASTAL POINTE DR
Second Line	:	STE 300
City	:	JUPITER
State	:	FL
Zip	:	33477-5024
Country	:	US
Telephone Number	:	561-744-9122
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 HUGH DANIEL DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-7148
Country	:	US
Telephone Number	:	561-744-9122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	10/28/2020

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