Provider Demographics
NPI:1376520049
Name:BOWEN, VAUGHAN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:VAUGHAN
Middle Name:RICHARD
Last Name:BOWEN
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 1:4447 S CANYON RD STE 6
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-1889
Mailing Address - Country:US
Mailing Address - Phone:605-716-0548
Mailing Address - Fax:605-716-0447
Practice Address - Street 1:4447 S CANYON RD STE 6
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-1889
Practice Address - Country:US
Practice Address - Phone:605-716-0548
Practice Address - Fax:605-716-0447
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20580207Y00000X
MO2020030112207Y00000X
SD11214207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03182OtherBCBSNE
NE47053662300Medicaid
MO2000890207Medicaid
MO2000890207Medicaid