Individual
THURMAN RAY VAUGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3303 NORTHLAND DR, SUITE 301, AUSTIN, TX 78731-4945
(512) 458-9191
(512) 458-2330
Mailing address
3303 NORTHLAND DR, SUITE 301, AUSTIN, TX 78731-4945
(512) 458-9191
(512) 458-2330
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J2828
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00254T
MEDICARE GROUP ID
TX
01
—
00N24T
BCBS GROUP ID
TX
01
—
030005344
RAILROAD MEDICARE
TX
01
—
85W020
BLUE CROSS BLUE SHIELD
TX
01
—
J2828
TEXAS LICENSE NUMBER
TX
Enumeration date
04/12/2007
Last updated
07/08/2007
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