MEDICARE: MR. MICHAEL LEE VAUGHT DPH

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	183500000X	Pharmacist	9852	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9852	OTHER	OK	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1346350576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL LEE VAUGHT DPH

Provider Business Mailing Address
First Line	:	39701 W 21ST ST S
Second Line	:
City	:	MANNFORD
State	:	OK
Zip	:	74044-2835
Country	:	US
Telephone Number	:	918-865-7848
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 PLAZA CT
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-7915
Country	:	US
Telephone Number	:	918-245-9693
Fax Number	:	918-245-5906

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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