Individual
DR. WALLACE CARROLL VAUGHAN JR.
Active
Individual
DR. WALLACE CARROLL VAUGHAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
13438
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040002702
RR MCARE
—
01
—
17143
BLUE CROSS
—
05
—
528701330
—
AL
Enumeration date
10/17/2006
Last updated
11/13/2015
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