Individual
DR. GARY JESSE VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301
(505) 722-1000
Mailing address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
M9151
ID
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
M-9151
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14607531
—
NM
Enumeration date
06/13/2006
Last updated
07/23/2018
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