Provider Demographics
NPI:1205836038
Name:VAUGHAN, TERRILL ANDREW (PAC)
Entity type:Individual
Prefix:MR
First Name:TERRILL
Middle Name:ANDREW
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 WALNUT HILL LN STE 514
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4407
Mailing Address - Country:US
Mailing Address - Phone:214-345-2929
Mailing Address - Fax:214-345-2905
Practice Address - Street 1:5012 US HWY 75 STE 300
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4589
Practice Address - Country:US
Practice Address - Phone:903-416-6065
Practice Address - Fax:903-416-6068
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP42740363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N3607OtherBCBS
TXA005OtherTRICARE CHAMPUS
TX0020HDOtherGROUP BCBS
TX148913001Medicaid
TXPA03083Medicaid
TX148913001Medicaid
TXPA03083Medicaid
TXA005OtherTRICARE CHAMPUS