Individual
DIMITRI NICHOLAS PAGOULATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
6516 E MYRTLE AVE, BAKER, LA 70714-4348
(225) 774-7320
(225) 774-5432
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 774-7320
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200193
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1189871
—
LA
Enumeration date
07/02/2008
Last updated
03/14/2025
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