Provider Demographics
NPI:1710757794
Name:YEAGER, JESSE (CSFA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:YEAGER
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 GASTON AVE STE 124470
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-6126
Mailing Address - Country:US
Mailing Address - Phone:972-822-4587
Mailing Address - Fax:
Practice Address - Street 1:7324 GASTON AVE STE 124470
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-6126
Practice Address - Country:US
Practice Address - Phone:972-822-4587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178101208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)