Provider Demographics
NPI:1063509917
Name:VAUGHAN, PAUL A (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9080 HARRY HINES BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-1720
Mailing Address - Country:US
Mailing Address - Phone:214-631-7880
Mailing Address - Fax:214-631-7558
Practice Address - Street 1:9080 HARRY HINES BLVD
Practice Address - Street 2:STE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-1720
Practice Address - Country:US
Practice Address - Phone:214-631-7880
Practice Address - Fax:214-631-7558
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6973207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB117215OtherMEDICARE PTAN
TX00D08POtherBLUE CROSS BLUE SHIELD
TXTXB117214OtherMEDICARE GROUP PTAN
TX0325938-01Medicaid
TXTXB117215OtherMEDICARE PTAN