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General NPI Number Information
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NPI Number | 1366429722
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Entity Type | Individual
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Provider Name | STEVEN GLENN VAUGHAN MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 1301 MONTGOMERY RD
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City | GRAHAM
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State | TX
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Zip | 76450-4240
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Country | US
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Telephone | 520-882-2172
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Fax | 940-521-5289
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Provider Business Mailing Address
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Address Line | 1301 MONTGOMERY RD
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City | GRAHAM
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State | TX
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Zip | 76450-4240
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Country | US
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Telephone | 940-521-5412
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Fax | 940-521-5289
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 29930
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | Q1761
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License Number State | TX
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