Healthcare Provider Details

I. General information

NPI: 1700975570
Provider Name (Legal Business Name): JOHN H DRURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S 8TH AVE SUITE 104
STERLING CO
80751-4563
US

IV. Provider business mailing address

1405 S 8TH AVE SUITE 104
STERLING CO
80751-4563
US

V. Phone/Fax

Practice location:
  • Phone: 970-526-8181
  • Fax: 970-526-8178
Mailing address:
  • Phone: 970-526-8181
  • Fax: 970-526-8178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number48066
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5842A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20108
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4071
License Number StateSD
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number041374
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: