Provider Demographics
NPI:1952320715
Name:VAUGHAN, VIRGINIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:L
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2006
Mailing Address - Country:US
Mailing Address - Phone:405-418-3314
Mailing Address - Fax:405-418-5405
Practice Address - Street 1:609 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2006
Practice Address - Country:US
Practice Address - Phone:405-418-3314
Practice Address - Fax:405-418-5405
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15704207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100101890AMedicaid
OKE12495Medicare UPIN
OK100101890AMedicaid