Healthcare Provider Details

I. General information

NPI: 1013534643
Provider Name (Legal Business Name): TYLER BARRETT DRURY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SW 73RD ST # 69
SOUTH MIAMI FL
33143-4679
US

IV. Provider business mailing address

6200 SW 73RD ST # 69
SOUTH MIAMI FL
33143-4679
US

V. Phone/Fax

Practice location:
  • Phone: 786-662-5465
  • Fax: 768-662-5334
Mailing address:
  • Phone: 786-662-5465
  • Fax: 786-662-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS20206
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT020425
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS20206
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: