Provider Demographics
NPI:1194711127
Name:CAVENDER, VAUGHN ALAN (IDMT)
Entity type:Individual
Prefix:
First Name:VAUGHN
Middle Name:ALAN
Last Name:CAVENDER
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-7329
Mailing Address - Country:US
Mailing Address - Phone:801-612-2262
Mailing Address - Fax:
Practice Address - Street 1:7302 WARDLEIGH RD
Practice Address - Street 2:
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-5223
Practice Address - Country:US
Practice Address - Phone:801-586-1625
Practice Address - Fax:801-777-1521
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other