Provider Demographics
NPI:1689890261
Name:VAUGHAN, JULIANA FREM (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:FREM
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY
Mailing Address - Street 2:SLOT 512-7
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1004
Mailing Address - Fax:501-364-6291
Practice Address - Street 1:1 CHILDRENS WAY
Practice Address - Street 2:SLOT 512-7
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1004
Practice Address - Fax:501-364-6291
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-51562080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164734001Medicaid
AR5N852Medicare PIN