MEDICARE: DR. DENNIS RYAN VAUGHN DPM

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	213E00000X	Podiatrist	016005005	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1497789572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS RYAN VAUGHN DPM

Provider Business Mailing Address
First Line	:	1640 NORTH STATE HIGHWAY 121
Second Line	:
City	:	MT. ZION
State	:	IL
Zip	:	62549
Country	:	US
Telephone Number	:	217-864-1922
Fax Number	:	217-864-1953

Provider Business Practice Location Address
First Line	:	1640 NORTH STATE HIGHWAY 121
Second Line	:
City	:	MT. ZION
State	:	IL
Zip	:	62549
Country	:	US
Telephone Number	:	217-864-1922
Fax Number	:	217-864-1953

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	11/09/2016

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