Provider Demographics
NPI:1518123702
Name:IAGULLI, NICHOLAS DOMINIC (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DOMINIC
Last Name:IAGULLI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8210 MID CITIES BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:N RICHLND HLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-4701
Mailing Address - Country:US
Mailing Address - Phone:817-969-6030
Mailing Address - Fax:817-969-6039
Practice Address - Street 1:8210 MID CITIES BLVD
Practice Address - Street 2:STE 120
Practice Address - City:N RICHLND HLS
Practice Address - State:TX
Practice Address - Zip Code:76180-4701
Practice Address - Country:US
Practice Address - Phone:817-969-6030
Practice Address - Fax:817-969-6039
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2020-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN8793207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery