Provider Demographics
NPI:1679574917
Name:YAEGER, MATTHEW M (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:YAEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 WALNUT HILL LN
Mailing Address - Street 2:SUITE 225
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4208
Mailing Address - Country:US
Mailing Address - Phone:214-691-3535
Mailing Address - Fax:214-691-1044
Practice Address - Street 1:8325 WALNUT HILL LN
Practice Address - Street 2:SUITE 225
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4208
Practice Address - Country:US
Practice Address - Phone:214-691-3535
Practice Address - Fax:214-691-1044
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ5212OtherMEDICAL DOCTOR
TXG03369Medicare UPIN