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Individual

KENNETH WAYNE VAUGHN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
101 EAST WOOD ST, EMERGENCY CENTER, SPARTANBURG, SC 29303-3040
(864) 560-6000
(864) 560-4413
Mailing address
PO BOX 2168, SPARTANBURG, SC 29304-2168
(864) 560-4304
(864) 560-4413

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
16851
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
194177
MEDCAST
SC
01
20057606
SELECT HEALTH
SC
01
4214665
AETNA
SC
05
690555T
NC
01
P00760368
RAIL ROAD MEDICARE
SC
05
TL8042
SC
Enumeration date
05/16/2006
Last updated
01/11/2021
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