Provider Demographics
NPI:1184913873
Name:VAUGHAN ASSOCIATION OF OBSTETRICS AND GYNECOLOGY
Entity type:Organization
Organization Name:VAUGHAN ASSOCIATION OF OBSTETRICS AND GYNECOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-294-7112
Mailing Address - Street 1:210 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2664
Mailing Address - Country:US
Mailing Address - Phone:972-693-3078
Mailing Address - Fax:
Practice Address - Street 1:210 S BROAD ST
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2664
Practice Address - Country:US
Practice Address - Phone:972-294-7112
Practice Address - Fax:972-426-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-03
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282763601Medicaid