Provider Demographics
NPI:1023270030
Name:VAUGHAN, GREGORY GAWAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:GAWAYNE
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3256 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2412
Mailing Address - Country:US
Mailing Address - Phone:530-886-8630
Mailing Address - Fax:530-886-8629
Practice Address - Street 1:3256 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2412
Practice Address - Country:US
Practice Address - Phone:530-886-8630
Practice Address - Fax:530-886-8629
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA110068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
H1230ZMedicare PIN