Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | H6973 | TX |
NPI | 1063509917 |
---|---|
Provider Name | Paul A Vaughan |
First Address | Dallas, TX 75235-1720 |
Second Address | Dallas, TX 75235-1720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 31/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00D08P | BLUE CROSS BLUE SHIELD (01) | TX |
0325938-01 | (05) | TX |
B08349 | (02) | TX |
TXB117214 | MEDICARE GROUP PTAN (01) | TX |
TXB117215 | MEDICARE PTAN (01) | TX |