Provider Demographics
NPI:1023174414
Name:MARRA, DIEGO ESTEBAN (MD)
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:ESTEBAN
Last Name:MARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DIEGO
Other - Middle Name:ESTEBAN
Other - Last Name:GARCIA-MARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5310 HARVEST HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5826
Mailing Address - Country:US
Mailing Address - Phone:214-420-0650
Mailing Address - Fax:214-736-0512
Practice Address - Street 1:2801 S HULEN ST STE 400
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1528
Practice Address - Country:US
Practice Address - Phone:817-921-2838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5353207N00000X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology