Provider Demographics
NPI:1689623811
Name:VAUGHT, KEVIN ALTON (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALTON
Last Name:VAUGHT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7910 W JEFFERSON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-969-7137
Practice Address - Fax:260-435-7672
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2024-08-14
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Provider Licenses
StateLicense IDTaxonomies
IN01092890A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG91935Medicare UPIN