Provider Demographics
NPI:1679516744
Name:MORGAN, VAUGHN M (MD)
Entity Type:Individual
Prefix:
First Name:VAUGHN
Middle Name:M
Last Name:MORGAN
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:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82602-1710
Mailing Address - Country:US
Mailing Address - Phone:307-233-6000
Mailing Address - Fax:307-235-6202
Practice Address - Street 1:5647 U.S. HWY 26
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:WY
Practice Address - Zip Code:82513
Practice Address - Country:US
Practice Address - Phone:307-455-2516
Practice Address - Fax:307-455-2526
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3330A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1188291Medicaid
WY1188291Medicaid
WYW9757Medicare PIN