1588177935 NPI number — BRYAN CHRISTOPHER VAUGHN

Table of content: BRYAN CHRISTOPHER VAUGHN (NPI 1588177935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588177935 NPI number — BRYAN CHRISTOPHER VAUGHN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAUGHN
Provider First Name:
BRYAN
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588177935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2488 E 81ST ST STE 290
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74137-4265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-927-3226
Provider Business Mailing Address Fax Number:
918-927-3193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7951 COL MCKINEY PKWY STE 700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75070-7852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-495-0763
Provider Business Practice Location Address Fax Number:
214-383-1492
Provider Enumeration Date:
11/08/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1299021 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 5950 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)