MEDICARE: DR. JEFFERSON ROGER VAUGHAN SR. 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	208600000X	Surgery Physician	ME0055039	FL
2	208600000X	Surgery Physician	00026990	AL

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	:	1780649988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERSON ROGER VAUGHAN SR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7532
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33468-7532
Country	:	US
Telephone Number	:	561-741-5695
Fax Number	:	561-741-5697

Provider Business Practice Location Address
First Line	:	1002 S OLD DIXIE HWY
Second Line	:	STE 203
City	:	JUPITER
State	:	FL
Zip	:	33458-7202
Country	:	US
Telephone Number	:	561-741-5695
Fax Number	:	561-741-5697

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	10/02/2007

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