Healthcare Provider Details

I. General information

NPI: 1578684056
Provider Name (Legal Business Name): JONATHAN A BIELFIELD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JONATHAN ADAM BIELFIELD DO

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W 34TH ST
AUSTIN TX
78703-1433
US

IV. Provider business mailing address

1500 W 34TH ST
AUSTIN TX
78703-1433
US

V. Phone/Fax

Practice location:
  • Phone: 512-485-7700
  • Fax: 512-485-7702
Mailing address:
  • Phone: 512-485-7700
  • Fax: 512-485-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberS8528
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: