Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | E0372 | TX |
NPI | 1053305771 |
---|---|
Provider Name | Dr. Gary Edward Vaughn |
First Address | Beaumont, TX 77701-4600 |
Second Address | Beaumont, TX 77701-4600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C22943 | (02) |