Provider Demographics
NPI:1801031992
Name:AGLIECO, FABIO G (DO)
Entity Type:Individual
Prefix:
First Name:FABIO
Middle Name:G
Last Name:AGLIECO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2660
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77404-2660
Mailing Address - Country:US
Mailing Address - Phone:979-345-6522
Mailing Address - Fax:979-345-4922
Practice Address - Street 1:513 S COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-3025
Practice Address - Country:US
Practice Address - Phone:979-345-6522
Practice Address - Fax:979-345-4922
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7986207RN0300X, 207R00000X
CT046940207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281158001Medicaid