MEDICARE: INTEGRATED NEUROLOGY AND NEUROPHYSIOLOGY OF NORTH TEXAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700873627	OTHER	TX	MR

General Provider Information

NPI Number	:	1720609811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED NEUROLOGY AND NEUROPHYSIOLOGY OF NORTH TEXAS

Provider Business Mailing Address
First Line	:	120 E FM 544 STE 72
Second Line	:
City	:	MURPHY
State	:	TX
Zip	:	75094-4035
Country	:	US
Telephone Number	:	972-422-0140
Fax Number	:	972-422-0140

Provider Business Practice Location Address
First Line	:	521 W SOUTHLAKE BLVD STE 100
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6173
Country	:	US
Telephone Number	:	817-328-3000
Fax Number	:	827-328-3333

Authorized Official
Title or Position	:	NEUROLOGIST
Name	:	DR. JOSEPH K VAUGHAN JR.
Credential	:	MD
Telephone Number	:	972-520-6535

Provider Enumeration Date	:	04/30/2020
Last Update Date	:	04/30/2020

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