Provider Demographics
NPI:1790932960
Name:PAUL A VAUGHAN, MD, PA
Entity Type:Organization
Organization Name:PAUL A VAUGHAN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-631-7880
Mailing Address - Street 1:9080 HARRY HINES BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-1720
Mailing Address - Country:US
Mailing Address - Phone:214-631-7880
Mailing Address - Fax:214-631-7558
Practice Address - Street 1:9080 HARRY HINES BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-1720
Practice Address - Country:US
Practice Address - Phone:214-631-7880
Practice Address - Fax:214-631-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6973207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB117214OtherMEDICARE GROUP PTAN
TX0325938-01Medicaid
TXTXB117215OtherMEDICARE PTAN
TXB08349Medicare UPIN