Healthcare Provider Details

I. General information

NPI: 1942302021
Provider Name (Legal Business Name): RANDALL G DRYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 BLANDING ST
COLUMBIA SC
29201-3520
US

IV. Provider business mailing address

1910 BLANDING ST
COLUMBIA SC
29201-3520
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-4107
  • Fax:
Mailing address:
  • Phone: 803-256-4107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number18519
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: