Healthcare Provider Details

I. General information

NPI: 1376657049
Provider Name (Legal Business Name): ROBERT MERRILL DRYDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 N WILMOT RD
TUCSON AZ
85712-5154
US

IV. Provider business mailing address

1241 N WILMOT RD
TUCSON AZ
85712-5154
US

V. Phone/Fax

Practice location:
  • Phone: 520-722-0909
  • Fax: 520-722-6937
Mailing address:
  • Phone: 520-722-0909
  • Fax: 520-722-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number06151
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: