Healthcare Provider Details

I. General information

NPI: 1306836671
Provider Name (Legal Business Name): GARY JAMES DROUILLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 HUEBNER RD
SAN ANTONIO TX
78240-1803
US

IV. Provider business mailing address

1450 W LONG LAKE RD STE 340
TROY MI
48098-6330
US

V. Phone/Fax

Practice location:
  • Phone: 210-541-5300
  • Fax: 210-541-5310
Mailing address:
  • Phone: 248-905-5091
  • Fax: 248-905-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberQ4091
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberQ4091
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: