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NPI Code Detail

MEDICARE: JEANNETTE VAUGHN-DOTTERER DMSC, PA-C

MEDICARE: JEANNETTE VAUGHN-DOTTERER DMSC, PA-C
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
1363A00000XPhysician Assistant2896AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407859416
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNETTE VAUGHN-DOTTERER DMSC, PA-C
Provider Business Mailing Address
First Line : 3033 N CENTRAL AVE STE 145
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2808
Country : US
Telephone Number : 480-964-2273
Fax Number : 623-974-6721
Provider Business Practice Location Address
First Line : 9610 N METRO PKWY W
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-1402
Country : US
Telephone Number : 480-964-2273
Fax Number : 602-843-1560
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 09/05/2025

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