MEDICARE: DR. JOHN S DRYDEN 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	208800000X	Urology Physician	E8446	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00474272	OTHER	TX	RAILROAD MEDICARE
3	0243510001	OTHER	TX	MEDICARE DME, PALMETTO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AT661	OTHER	TX	BLUE CROSS & BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821076035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN S DRYDEN M.D.

Provider Business Mailing Address
First Line	:	5500 KELL BLVD
Second Line	:	SUITE 200
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-1612
Country	:	US
Telephone Number	:	940-689-8765
Fax Number	:	940-689-8769

Provider Business Practice Location Address
First Line	:	5500 KELL
Second Line	:	SUITE 200
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-1612
Country	:	US
Telephone Number	:	940-689-8765
Fax Number	:	940-689-8769

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	06/10/2008

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Directions to “ DR. JOHN S DRYDEN M.D.” Practice Location

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