Individual
STORM BRADLEY VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845
(260) 425-6030
(260) 425-6028
Mailing address
3702 NEW VISION DR BLDG B, FORT WAYNE, IN 46845-1703
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
75000046A
IN
367H00000X
Anesthesiologist Assistant
Primary
AA484
FL
367H00000X
Anesthesiologist Assistant
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Other
Enumeration date
06/26/2018
Last updated
10/31/2025
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