MEDICARE: DR. DRURY L. WOODSON M.D.

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	207R00000X	Internal Medicine Physician	D2636	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0053KD	OTHER	TX	BLUE CROSS AND BLUE SHIEL

General Provider Information

NPI Number	:	1467476242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DRURY L. WOODSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1263
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-1263
Country	:	US
Telephone Number	:	409-933-0733
Fax Number	:	409-933-9777

Provider Business Practice Location Address
First Line	:	622 HIGHWAY 3
Second Line	:
City	:	LA MARQUE
State	:	TX
Zip	:	77568-5936
Country	:	US
Telephone Number	:	409-933-0733
Fax Number	:	409-933-9777

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/04/2011

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