MEDICARE: GERALD DRYDEN MD

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	207RG0100X	Gastroenterology Physician	33791	KY
2	207R00000X	Internal Medicine Physician	33791	KY

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

General Provider Information

NPI Number	:	1619969011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD DRYDEN MD

Provider Business Mailing Address
First Line	:	PO BOX 909
Second Line	:	SUITE 220
City	:	LOUISVILLE
State	:	KY
Zip	:	40201-0909
Country	:	US
Telephone Number	:	502-588-0320
Fax Number	:	502-588-0326

Provider Business Practice Location Address
First Line	:	401 E CHESTNUT ST
Second Line	:	SUITE 310
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-5700
Country	:	US
Telephone Number	:	502-584-8563
Fax Number	:	502-562-6196

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	02/14/2017

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Directions to “ GERALD DRYDEN MD” Practice Location

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