Provider Demographics
NPI:1265503197
Name:CAUGHEY, ROBERT JASON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JASON
Last Name:CAUGHEY
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 1:3341 BEALE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1549
Mailing Address - Country:US
Mailing Address - Phone:814-944-5357
Mailing Address - Fax:814-946-8017
Practice Address - Street 1:3341 BEALE AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-1549
Practice Address - Country:US
Practice Address - Phone:814-944-5357
Practice Address - Fax:814-946-8017
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430275207Y00000X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019045700001Medicaid
CA1956813OtherBLUE SHIELD
PAP00400431OtherMEDICARE RAILROAD
PAMD430275OtherSTATE LICENSE
PA1019045700001Medicaid