Healthcare Provider Details

I. General information

NPI: 1316923956
Provider Name (Legal Business Name): JEFFREY L DRYDEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N KENTUCKY AVE
WEST PLAINS MO
65775-2029
US

IV. Provider business mailing address

P.O. BOX 1100
WEST PLAINS MO
65775-1100
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-9111
  • Fax: 417-257-5999
Mailing address:
  • Phone: 417-257-5800
  • Fax: 417-257-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR5D34
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberR5D34
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: