MEDICARE: JEFFERSON R VAUGHAN MD FACS PC

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	26990	AL

General Provider Information

NPI Number	:	1932146354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON R VAUGHAN MD FACS PC

Provider Business Mailing Address
First Line	:	48 MEDICAL PARK DR E
Second Line	:	STE 150
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3400
Country	:	US
Telephone Number	:	205-838-3520
Fax Number	:	205-838-3124

Provider Business Practice Location Address
First Line	:	48 MEDICAL PARK DR E
Second Line	:	STE 150
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3400
Country	:	US
Telephone Number	:	205-838-3520
Fax Number	:	205-838-3124

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFERSON R VAUGHAN
Credential	:	MD
Telephone Number	:	205-838-3520

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/22/2020

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