Most Relevant Information
Provider Data
| NPI Number: | 1003025826 |
| Provider Name: | MARTIN VAUGHN CRNA |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 2005030753 |
Most Important Dates
| Enumeration Date: | 05/21/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
2620 N WESTWOOD BLVD
POPLAR BLUFF
MO
639013396
Practice Location Phone/Fax
| Phone: | 5737857721 |
| Fax: |
Provider Mailing Location
280 CR 782
JONESBORO
AR
72401
Provider Mailing Phone/Fax
| Phone: | 8709729454 |
| Fax: |