Provider Demographics
NPI:1689746448
Name:VUGRIN, DAVOR (MD)
Entity type:Individual
Prefix:DR
First Name:DAVOR
Middle Name:
Last Name:VUGRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 INDIANA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2139
Mailing Address - Country:US
Mailing Address - Phone:806-793-0988
Mailing Address - Fax:806-793-1697
Practice Address - Street 1:2232 INDIANA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2139
Practice Address - Country:US
Practice Address - Phone:806-793-0988
Practice Address - Fax:806-793-1697
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH1235207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F37NOtherBLUE CROSS PROVIDER #
TX098261301Medicaid
TX752380470OtherTRICARE #
TXB27375Medicare UPIN
TX00F37NOtherBLUE CROSS PROVIDER #