Provider Demographics
NPI:1366429722
Name:VAUGHAN, STEVEN GLENN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:GLENN
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-4240
Mailing Address - Country:US
Mailing Address - Phone:940-521-5412
Mailing Address - Fax:940-521-5289
Practice Address - Street 1:1301 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4240
Practice Address - Country:US
Practice Address - Phone:520-882-2172
Practice Address - Fax:940-521-5289
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29930208600000X
TXQ1761208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX401019101Medicaid
H57104Medicare UPIN