Individual
THOMAS KEITH VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
929 E MAIN AVE, STE 210, PUYALLUP, WA 98372-3116
(253) 841-2453
(253) 840-5519
Mailing address
929 E MAIN AVE, STE 210, PUYALLUP, WA 98372-3116
(253) 841-2453
(253) 840-5519
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD00044588
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0236932
L&I
WA
01
—
53030 GROUP
L&I
WA
05
—
7095656
—
WA
05
—
8422511
—
WA
01
—
CS6844 GROUP
RR MED
—
01
—
P00642708
RR MEDICARE
—
Enumeration date
08/05/2006
Last updated
01/28/2010
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