Provider Demographics
NPI:1962571273
Name:VAUGHAN, LENORA BROOKE (DO)
Entity type:Individual
Prefix:DR
First Name:LENORA
Middle Name:BROOKE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LENORA
Other - Middle Name:BROOKE
Other - Last Name:GOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4085 OHIO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6245
Mailing Address - Country:US
Mailing Address - Phone:972-335-1490
Mailing Address - Fax:972-335-1491
Practice Address - Street 1:4085 OHIO DR STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6245
Practice Address - Country:US
Practice Address - Phone:972-335-1490
Practice Address - Fax:972-335-1491
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4951207V00000X
VA0102202735207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181348702Medicaid
TX181348702Medicaid