Healthcare Provider Details

I. General information

NPI: 1326107236
Provider Name (Legal Business Name): TINA MARIE DRURY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOSPITAL DR
COLUMBIA MO
65201-5276
US

IV. Provider business mailing address

600 E 5TH ST
FULTON MO
65251-1753
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-1300
  • Fax: 573-884-1010
Mailing address:
  • Phone: 573-592-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number113170
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: