Provider Demographics
NPI:1205847936
Name:ROUGHNEEN, PATRICK THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:THOMAS
Last Name:ROUGHNEEN
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 1:1600 W COLLEGE ST
Mailing Address - Street 2:SUITE 555
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3580
Mailing Address - Country:US
Mailing Address - Phone:817-552-1900
Mailing Address - Fax:817-552-1902
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 555
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-552-1900
Practice Address - Fax:817-552-1902
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ14802086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0053MAOtherBLUE CROSS/BLUE SHIELDS
TX171001401Medicaid
TX171001405Medicaid
TX171001404Medicaid
TXDE9002OtherRAILROAD MEDICARE PIN
TX0053MAOtherBLUE CROSS/BLUE SHIELDS
TX171001405Medicaid
TX171001401Medicaid
TX8D0857Medicare ID - Type UnspecifiedDALLAS COUNTY