Individual
GLEN E VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2801 BAY PARK DR, OREGON, OH 43616-4920
(419) 690-7900
Mailing address
PO BOX 633390, CINCINNATI, OH 45263-3390
(800) 594-1876
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35053859
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000246976
ANTHEM
OH
01
—
000000550256
ANTHEM
OH
05
—
0634497
—
OH
05
—
4488340
—
MI
Enumeration date
08/19/2005
Last updated
10/14/2009
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