Provider Demographics
NPI:1336303080
Name:VAUGHN, LISA ANITA (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANITA
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2000 OPELOUSAS STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-439-9983
Mailing Address - Fax:337-439-3224
Practice Address - Street 1:2000 OPELOUSAS STREET
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-439-9983
Practice Address - Fax:337-439-3224
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LADO.000138174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist