Provider Demographics
NPI:1720609811
Name:INTEGRATED NEUROLOGY AND NEUROPHYSIOLOGY OF NORTH TEXAS
Entity type:Organization
Organization Name:INTEGRATED NEUROLOGY AND NEUROPHYSIOLOGY OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:972-520-6535
Mailing Address - Street 1:120 E FM 544 STE 72
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4035
Mailing Address - Country:US
Mailing Address - Phone:972-422-0140
Mailing Address - Fax:972-422-0140
Practice Address - Street 1:521 W SOUTHLAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6173
Practice Address - Country:US
Practice Address - Phone:817-328-3000
Practice Address - Fax:827-328-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1700873627OtherMR