Provider Demographics
NPI:1326061003
Name:CONNAUGHTON, ROBERT H (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:CONNAUGHTON
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 1:800 8TH AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2602
Mailing Address - Country:US
Mailing Address - Phone:682-224-3748
Mailing Address - Fax:682-841-0039
Practice Address - Street 1:1105 CENTRAL EXPY N STE 350
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6104
Practice Address - Country:US
Practice Address - Phone:692-848-9904
Practice Address - Fax:469-382-9362
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK80922086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046848001Medicaid
TX87900XOtherBLUE CROSS OF TEXAS
TX1326061003OtherNPI
G95557Medicare UPIN
TX87900XOtherBLUE CROSS OF TEXAS
020045835Medicare ID - Type UnspecifiedRAILROAD MEDICARE