Provider Demographics
NPI:1528242336
Name:DELAUGHTER, MICHAEL CRAIG (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CRAIG
Last Name:DELAUGHTER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 AIRPORT FWY STE 301
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6604
Mailing Address - Country:US
Mailing Address - Phone:682-292-9000
Mailing Address - Fax:844-289-7694
Practice Address - Street 1:1305 AIRPORT FWY
Practice Address - Street 2:SUITE 301
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6605
Practice Address - Country:US
Practice Address - Phone:682-292-9000
Practice Address - Fax:844-289-7694
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7353207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196514704Medicaid
TX8CL891OtherBCBS
TX196514701Medicaid
TX8K9245Medicare PIN
TX196514704Medicaid
TX196514701Medicaid