Healthcare Provider Details

I. General information

NPI: 1487883716
Provider Name (Legal Business Name): ROBERT DRURY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8836 FERNCLIFF AVE NE
BAINBRIDGE ISLAND WA
98110-2907
US

IV. Provider business mailing address

8836 FERNCLIFF AVE NE
BAINBRIDGE ISLAND WA
98110-2907
US

V. Phone/Fax

Practice location:
  • Phone: 206-941-4882
  • Fax:
Mailing address:
  • Phone: 206-941-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY1911
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: