Provider Demographics
NPI:1083838015
Name:VAUGHAN, THURMAN RAY (MD)
Entity Type:Individual
Prefix:
First Name:THURMAN
Middle Name:RAY
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 1:3303 NORTHLAND DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4945
Mailing Address - Country:US
Mailing Address - Phone:512-458-9191
Mailing Address - Fax:512-458-2330
Practice Address - Street 1:3303 NORTHLAND DR
Practice Address - Street 2:SUITE 301
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4945
Practice Address - Country:US
Practice Address - Phone:512-458-9191
Practice Address - Fax:512-458-2330
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2828174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85W020OtherBLUE CROSS BLUE SHIELD
TXJ2828OtherTEXAS LICENSE NUMBER
TX030005344OtherRAILROAD MEDICARE
TX00254TOtherMEDICARE GROUP ID
TX00N24TOtherBCBS GROUP ID
TX85W020OtherBLUE CROSS BLUE SHIELD
TX8502B1Medicare ID - Type Unspecified