# VAUGHN D JACKSON, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710308952
- **Authorized official:** DR. VAUGHN D JACKSON M.D. (SOLE MEMBER)
- **Authorized official phone:** (719) 274-4500

## Contact information

- **Practice address:** 412 MAIN, LA JARA, CO 81140
- **Practice address phone:** (719) 274-4500
- **Practice address fax:** (719) 274-4504
- **Mailing address:** P.O. BOX 272, 416 MAIN, LA JARA, CO 81140
- **Mailing address phone:** (719) 274-4500
- **Mailing address fax:** (719) 274-4504

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 31351 | CO | Yes |

## Other

- **Enumeration date:** 12/13/2013
- **Last updated:** 12/13/2013