Healthcare Provider Details

I. General information

NPI: 1053305771
Provider Name (Legal Business Name): GARY EDWARD VAUGHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 HOSPITAL DR #240
BEAUMONT TX
77701-4600
US

IV. Provider business mailing address

810 HOSPITAL DR #240
BEAUMONT TX
77701-4600
US

V. Phone/Fax

Practice location:
  • Phone: 409-833-0017
  • Fax: 409-833-9731
Mailing address:
  • Phone: 409-833-0017
  • Fax: 409-833-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberE0372
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberE0372
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: