Provider Demographics
NPI:1689671059
Name:YEAGER, SHANA L (MD)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:L
Last Name:YEAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 LOUETTA ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4405
Mailing Address - Country:US
Mailing Address - Phone:281-444-1770
Mailing Address - Fax:281-444-4739
Practice Address - Street 1:4002 LOUETTA ROAD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4405
Practice Address - Country:US
Practice Address - Phone:281-444-1770
Practice Address - Fax:281-444-4739
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4839207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174312204Medicaid
TX174312205Medicaid
TX174312203Medicaid
TX8CA788OtherBCBS
TX174312204Medicaid
TX174312203Medicaid