Provider Demographics
NPI:1649263740
Name:VAUGHN, ADRIANNE DEWALT (MD)
Entity type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:DEWALT
Last Name:VAUGHN
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 1:21314 W TEJAS TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1691
Mailing Address - Country:US
Mailing Address - Phone:210-326-3187
Mailing Address - Fax:210-404-0926
Practice Address - Street 1:115 GALLERY CIR STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3492
Practice Address - Country:US
Practice Address - Phone:210-499-0033
Practice Address - Fax:210-404-0926
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1970207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167437601Medicaid
TXG09979Medicare UPIN
TN00253TMedicare ID - Type UnspecifiedGROUP