Individual
DR. WALLACE CARROLL VAUGHAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6980 WINTON BLOUNT BLVD, MONTGOMERY, AL 36117-3556
(334) 277-0484
(334) 272-8877
Mailing address
6980 WINTON BLOUNT BLVD, MONTGOMERY, AL 36117-3556
(334) 277-0484
(334) 272-8877
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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