Provider Demographics
NPI:1083144778
Name:VAUGHN-VALENCIA, MICAH MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:MARTIN
Last Name:VAUGHN-VALENCIA
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 1:500 W MAIN ST APT 312
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-2209
Mailing Address - Country:US
Mailing Address - Phone:903-327-5546
Mailing Address - Fax:
Practice Address - Street 1:1100 N LINDSAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5410
Practice Address - Country:US
Practice Address - Phone:405-271-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8260207V00000X
TXBP10060908207V00000X
OK38003207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology