Basic Information
| Provider Information | |||||||||
| NPI: | 1326061003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNAUGHTON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 MAUI LANI PKWY | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967932416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302410473 | ||||||||
| FaxNumber: | 8558272321 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 MAUI LANI PKWY | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967932416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084425700 | ||||||||
| FaxNumber: | 8558272321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 07/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | K8092 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | K8092 | TX | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1326061003 | 01 | TX | NPI | OTHER | 046848001 | 05 | TX | MEDICAID | 87900X | 01 | TX | BLUE CROSS OF TEXAS | OTHER |