MEDICARE: DR. CHARLES BURTON DRURY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	7692	CA

General Provider Information

NPI Number	:	1043360100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES BURTON DRURY PHD

Provider Business Mailing Address
First Line	:	1402 CATALINA STREET
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651
Country	:	US
Telephone Number	:	949-584-6909
Fax Number	:	949-497-6909

Provider Business Practice Location Address
First Line	:	1402 CATALINA STREET
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651
Country	:	US
Telephone Number	:	949-584-6909
Fax Number	:	949-497-6909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	09/03/2013

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