Individual
MR. THOMAS DEWAYNE VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1500 ROSS CLARK CIR, DOTHAN, AL 36301-4754
(334) 793-2663
Mailing address
PO BOX 729, DOTHAN, AL 36302-0729
(334) 793-2663
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
779
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I977212
MEDICARE
AL
05
—
188125
—
AL
05
—
189447
—
AL
01
—
511-79539
BCBS OF ALABAMA -RCC
AL
01
—
511-79540
BCBS OF ALABAMA - HWEST
AL
Enumeration date
08/26/2005
Last updated
09/12/2016
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