Healthcare Provider Details

I. General information

NPI: 1073866232
Provider Name (Legal Business Name): ANGELA L DRURY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 WESTERN TRAILS SUITE 103
AUSTIN TX
78745-1642
US

IV. Provider business mailing address

101 HOSPTIAL LOOP NE SUITE 115
ALBUQUERQUE NM
87109-2129
US

V. Phone/Fax

Practice location:
  • Phone: 512-382-0773
  • Fax: 512-382-0072
Mailing address:
  • Phone: 505-883-6600
  • Fax: 505-883-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1876
License Number StateTX

VIII. Authorized Official

Name: ANGELA L DRURY
Title or Position: PRESIDENT
Credential: DPM
Phone: 512-382-0773