Provider Demographics
NPI:1093509077
Name:MCCALL, VAUGHN LEON SR
Entity type:Individual
Prefix:MR
First Name:VAUGHN
Middle Name:LEON
Last Name:MCCALL
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N WYMORE RD
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6104
Mailing Address - Country:US
Mailing Address - Phone:407-617-0673
Mailing Address - Fax:
Practice Address - Street 1:103 N WYMORE RD
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32751-6104
Practice Address - Country:US
Practice Address - Phone:407-617-0673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL01860261744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management