Provider Demographics
NPI:1316905672
Name:VAUGHAN, PATRICK J (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:117 WEST BUNNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-772-7313
Mailing Address - Fax:805-772-0395
Practice Address - Street 1:685 MORRO AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2233
Practice Address - Country:US
Practice Address - Phone:805-772-7313
Practice Address - Fax:805-772-0395
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G457940OtherBLUE SHIELD PIN
CACB234882OtherMEDICARE ID
CAG045794Medicaid
CAA50185Medicare UPIN
WG45794NMedicare PIN