Healthcare Provider Details

I. General information

NPI: 1801069182
Provider Name (Legal Business Name): NICHOLAS ADAM FLUGSTAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3327 COLORADO BLVD STE 100
DENTON TX
76210-6866
US

IV. Provider business mailing address

800 8TH AVE STE 206
FORT WORTH TX
76104-2619
US

V. Phone/Fax

Practice location:
  • Phone: 940-287-3795
  • Fax:
Mailing address:
  • Phone: 817-529-9199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD.60544566
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number04-49255
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberS5897
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: