Provider Demographics
NPI:1649215641
Name:VAUGHAN, THOMAS H JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
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:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-745-2601
Practice Address - Street 1:1141 KELLER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1628
Practice Address - Country:US
Practice Address - Phone:817-741-2601
Practice Address - Fax:817-745-2601
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6189207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034841902Medicaid