MEDICARE: TYLER VAUGHN

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	246ZC0007X	Surgical Assistant	238.000328	IL
2	246ZC0007X	Surgical Assistant	0136000046	VA

General Provider Information

NPI Number	:	1194248930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER VAUGHN

Provider Business Mailing Address
First Line	:	7324 SOUTHWEST FWY STE 500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2003
Country	:	US
Telephone Number	:	713-779-9800
Fax Number	:	713-779-9862

Provider Business Practice Location Address
First Line	:	7324 SOUTHWEST FWY STE 500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2003
Country	:	US
Telephone Number	:	713-779-9800
Fax Number	:	713-779-9862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	07/21/2022

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Directions to “ TYLER VAUGHN ” Practice Location

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