Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | M5353 | TX |
Y | 207ND0101X | MOHS-Micrographic Surgeon | M5353 | TX |
N | 207NS0135X | Procedural Dermatology | M5353 | TX |
NPI | 1023174414 |
---|---|
Provider Name | Diego Esteban Marra |
First Address | Dallas, TX 75230-5826 |
Second Address | Fort Worth, TX 76109-1528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 13/10/2017 |