MEDICARE: JAMES A DRURY

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	2084P0804X	Child & Adolescent Psychiatry Physician	9701737	NC
2	2084P0804X	Child & Adolescent Psychiatry Physician	OS14634	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2076034	OTHER	NC	NC MEDICARE

General Provider Information

NPI Number	:	1982664595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES A DRURY

Provider Business Mailing Address
First Line	:	1062 LAKE SEBRING DRIVE
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-1426
Country	:	US
Telephone Number	:	863-658-0116
Fax Number	:	863-471-6868

Provider Business Practice Location Address
First Line	:	4711 PEBBLE BEACH DR
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-1735
Country	:	US
Telephone Number	:	252-340-0915
Fax Number	:

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	03/08/2022

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