MEDICARE: TAMMY DRERUP O.P.A.C., R.T.

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	363AS0400X	Surgical Physician Assistant
2	163W00000X	Registered Nurse	982426	TX

General Provider Information

NPI Number	:	1215927488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY DRERUP O.P.A.C., R.T.

Provider Business Mailing Address
First Line	:	7510 ECHO PINES DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-3140
Country	:	US
Telephone Number	:	281-989-7442
Fax Number	:

Provider Business Practice Location Address
First Line	:	7510 ECHO PINES DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-3140
Country	:	US
Telephone Number	:	281-989-7442
Fax Number	:

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/06/2021

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