Healthcare Provider Details

I. General information

NPI: 1083144778
Provider Name (Legal Business Name): MICAH MARTIN VAUGHN-VALENCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4307
US

IV. Provider business mailing address

1317B MINOR AVE
SEATTLE WA
98101-2851
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6000
  • Fax:
Mailing address:
  • Phone: 903-327-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberS8260
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number0101281541
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD.MD.70162304
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: