Healthcare Provider Details

I. General information

NPI: 1912982018
Provider Name (Legal Business Name): JASON DENNIS ZAGRODZKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 JAMES CASEY BLDG, C, SUITE 201
AUSTIN TX
78745
US

IV. Provider business mailing address

4316 JAMES CASEY BLDG, C, SUITE 201
AUSTIN TX
78745
US

V. Phone/Fax

Practice location:
  • Phone: 512-381-0170
  • Fax: 512-381-0171
Mailing address:
  • Phone: 512-381-0170
  • Fax: 512-381-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberJ4632
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberJ4632
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: