Provider Demographics
NPI:1932393360
Name:LYNN ANN VAUGHAN, MD, LTD
Entity Type:Organization
Organization Name:LYNN ANN VAUGHAN, MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-682-8900
Mailing Address - Street 1:989 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-1232
Mailing Address - Country:US
Mailing Address - Phone:913-682-8900
Mailing Address - Fax:913-651-2007
Practice Address - Street 1:920 6TH AVE
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3225
Practice Address - Country:US
Practice Address - Phone:913-682-8900
Practice Address - Fax:913-651-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS27598207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110783OtherBLUE CROSS BLUE SHIELD
KS110783Medicare PIN