Provider Demographics
NPI:1972506608
Name:VAUGHN, MARK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:VAUGHN
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 1:2850 LEWIS LN
Mailing Address - Street 2:STE 107
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9378
Mailing Address - Country:US
Mailing Address - Phone:903-783-9434
Mailing Address - Fax:903-783-9441
Practice Address - Street 1:2850 LEWIS LN
Practice Address - Street 2:STE 107
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9378
Practice Address - Country:US
Practice Address - Phone:903-783-9434
Practice Address - Fax:903-783-9441
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-26
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7225207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096353001Medicaid
TXG90178Medicare UPIN
TX00167JMedicare PIN