Provider Demographics
NPI:1720076987
Name:GAUGHAN, ROBERT K (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:GAUGHAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9701 LANDMARK PARKWAY DR
Mailing Address - Street 2:STE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1665
Mailing Address - Country:US
Mailing Address - Phone:314-843-3828
Mailing Address - Fax:314-843-3052
Practice Address - Street 1:12399 GRAVOIS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1750
Practice Address - Country:US
Practice Address - Phone:314-843-3828
Practice Address - Fax:314-843-3052
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2020-04-23
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Provider Licenses
StateLicense IDTaxonomies
MO100201207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E59184Medicare UPIN
MO004013883Medicare PIN