Provider Demographics
NPI:1154336212
Name:DHRUVA, ACHAL R (MD)
Entity type:Individual
Prefix:DR
First Name:ACHAL
Middle Name:R
Last Name:DHRUVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SETON CENTER PKWY
Mailing Address - Street 2:SUITE 215 - CREDENTIALING
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5290
Mailing Address - Country:US
Mailing Address - Phone:512-231-5506
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1401 MEDICAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5026
Practice Address - Country:US
Practice Address - Phone:512-260-1581
Practice Address - Fax:512-406-7309
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3209207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187002401Medicaid
TX187002402Medicaid
TX187002401Medicaid
TXP00378778Medicare PIN
TX8J3048Medicare PIN