Provider Demographics
NPI:1518026319
Name:VAUGHAN, TOM BROOKS JR (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:BROOKS
Last Name:VAUGHAN
Suffix:JR
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 1:2204 LAKESHORE DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6729
Mailing Address - Country:US
Mailing Address - Phone:205-870-5678
Mailing Address - Fax:205-879-0071
Practice Address - Street 1:2204 LAKESHORE DR
Practice Address - Street 2:SUITE 410
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6729
Practice Address - Country:US
Practice Address - Phone:205-870-5678
Practice Address - Fax:205-879-0071
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL64202084P0804X
ALMD.64202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-02331OtherFEDERAL BC
AL000082996Medicaid
AL510-24822OtherBCBS
AL000024822Medicaid
AL1518026319OtherTRICARE SOUTH
AL510-82996OtherBCBS
AL515-02331OtherFEDERAL BC