Provider Demographics
NPI:1801100342
Name:YAGER, MARIANA BRAGA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:BRAGA
Last Name:YAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIANA
Other - Middle Name:BRAGA
Other - Last Name:RESENDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 VICEROY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2208
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6966
Practice Address - Street 1:1250 8TH AVE STE 500
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4145
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4131207RN0300X
NH16296207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3080731-02Medicaid
NHT400109725Medicare PIN