Provider Demographics
NPI:1881687879
Name:VAUGHN, MICHAEL PATRICK (MDPHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:MDPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GALLERY CIRCLE STE. 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3492
Mailing Address - Country:US
Mailing Address - Phone:210-499-0033
Mailing Address - Fax:210-404-0926
Practice Address - Street 1:115 GALLERY CIR
Practice Address - Street 2:STE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3388
Practice Address - Country:US
Practice Address - Phone:210-499-0033
Practice Address - Fax:210-404-0926
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7242207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133677801Medicaid
TX167435001Medicaid
TX167435001Medicaid
TXE82742Medicare UPIN
TX00253TMedicare ID - Type UnspecifiedGROUP