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Organization

SPACE COAST PODIATRY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARK ALLEN VAUGHN DPM (CEO/PHYSICIAN)
(321) 802-4075
Entity
Organization

Contact information

Practice address
6100 MINTON RD NW STE 101, PALM BAY, FL 32907-1900
(321) 802-4075
Mailing address
6100 MINTON RD NW STE 101, PALM BAY, FL 32907-1900
(321) 802-4075

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary

Other

Enumeration date
04/30/2024
Last updated
09/09/2024
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