Provider Demographics
NPI:1336239979
Name:WAY, BILL VAUGHN (DO)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:VAUGHN
Last Name:WAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4568
Mailing Address - Country:US
Mailing Address - Phone:972-780-0707
Mailing Address - Fax:972-283-0167
Practice Address - Street 1:706 W CENTER ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4568
Practice Address - Country:US
Practice Address - Phone:972-780-0707
Practice Address - Fax:972-283-0167
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA67770Medicare UPIN
TX86Z040Medicare PIN