Healthcare Provider Details

I. General information

NPI: 1710757794
Provider Name (Legal Business Name): JESSE YEAGER CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7324 GASTON AVE STE 124470
DALLAS TX
75214-6126
US

IV. Provider business mailing address

7324 GASTON AVE STE 124470
DALLAS TX
75214-6126
US

V. Phone/Fax

Practice location:
  • Phone: 972-822-4587
  • Fax:
Mailing address:
  • Phone: 972-822-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number178101
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: