Healthcare Provider Details

I. General information

NPI: 1164420915
Provider Name (Legal Business Name): TROY MICHAEL VAUGHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 01/08/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 NORTH BLVD SUITE C
ALEXANDRIA LA
71301-3606
US

IV. Provider business mailing address

3704 NORTH BLVD SUITE C
ALEXANDRIA LA
71301-3606
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-4576
  • Fax: 318-449-5579
Mailing address:
  • Phone: 318-443-4576
  • Fax: 318-449-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD.021645
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: