Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | J1970 | TX |
NPI | 1649263740 |
---|---|
Provider Name | Dr. Adrianne Dewalt Vaughn |
First Address | San Antonio, TX 78255-1159 |
Second Address | San Antonio, TX 78258-3329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G09979 | (02) | TX |