Individual
ROLAND VAUGHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
970 LAKE CARILLON DR STE 300, ST PETERSBURG, FL 33716-1130
(303) 717-4336
Mailing address
970 LAKE CARILLON DR STE 300, ST PETERSBURG, FL 33716-1130
(303) 717-4336
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36510
—
FL
Enumeration date
09/29/2017
Last updated
07/21/2022
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