MEDICARE: SAMMY DWIGHT VAUGHT 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	207Y00000X	Otolaryngology Physician	ME76023	FL

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	:	1619977220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMMY DWIGHT VAUGHT M.D.

Provider Business Mailing Address
First Line	:	601 E DIXIE AVE
Second Line	:	MEDICAL PLAZA 901
City	:	LEESBURG
State	:	FL
Zip	:	34748-5953
Country	:	US
Telephone Number	:	352-728-2404
Fax Number	:	352-787-7401

Provider Business Practice Location Address
First Line	:	601 E DIXIE AVE
Second Line	:	MEDICAL PLAZA 901
City	:	LEESBURG
State	:	FL
Zip	:	34748-5953
Country	:	US
Telephone Number	:	352-728-2404
Fax Number	:	352-787-7401

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/15/2019

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