MEDICARE: DR. NICHOLAS DOMINIC IAGULLI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	N8793	TX

General Provider Information

NPI Number	:	1518123702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS DOMINIC IAGULLI MD

Provider Business Mailing Address
First Line	:	8210 MID CITIES BLVD
Second Line	:	SUITE 120
City	:	N RICHLND HLS
State	:	TX
Zip	:	76180-4701
Country	:	US
Telephone Number	:	817-969-6030
Fax Number	:	817-969-6039

Provider Business Practice Location Address
First Line	:	8210 MID CITIES BLVD
Second Line	:	STE 120
City	:	N RICHLND HLS
State	:	TX
Zip	:	76180-4701
Country	:	US
Telephone Number	:	817-969-6030
Fax Number	:	817-969-6039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	10/12/2020

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