Healthcare Provider Details

I. General information

NPI: 1124429923
Provider Name (Legal Business Name): DHRUVE SATISH JEEVAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 PARK BEND DR STE 400
AUSTIN TX
78758-5674
US

IV. Provider business mailing address

12319 N MOPAC EXPY STE 150
AUSTIN TX
78758-2648
US

V. Phone/Fax

Practice location:
  • Phone: 512-730-0000
  • Fax: 512-233-2370
Mailing address:
  • Phone: 512-837-7999
  • Fax: 512-837-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number277227
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberQ6519
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: