MEDICARE: DR. TIMOTHY JOSEPH VAUGHAN M.D.

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	208000000X	Pediatrics Physician	ME0071848	FL

General Provider Information

NPI Number	:	1538166608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY JOSEPH VAUGHAN M.D.

Provider Business Mailing Address
First Line	:	11747 82ND TER N
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772-4029
Country	:	US
Telephone Number	:	727-397-2061
Fax Number	:	727-584-9812

Provider Business Practice Location Address
First Line	:	1725 E BAY DR
Second Line	:	SUITE A
City	:	LARGO
State	:	FL
Zip	:	33771-2208
Country	:	US
Telephone Number	:	727-584-9810
Fax Number	:	727-584-9812

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/08/2007

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