MEDICARE: MR. JAMES W DRYDEN CPO

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	174400000X	Specialist	CPO00842	CA

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	:	1760537120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES W DRYDEN CPO

Provider Business Mailing Address
First Line	:	10711 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2312
Country	:	US
Telephone Number	:	818-753-1316
Fax Number	:	818-509-0451

Provider Business Practice Location Address
First Line	:	10711 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2312
Country	:	US
Telephone Number	:	818-753-1316
Fax Number	:	818-509-0451

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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