Basic Information
| Provider Information | |||||||||
| NPI: | 1700975570 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRURY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1405 S 8TH AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | STERLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807514563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705268181 | ||||||||
| FaxNumber: | 9705268178 | ||||||||
| Practice Location | |||||||||
| Address1: | 1405 S 8TH AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | STERLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807514563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705268181 | ||||||||
| FaxNumber: | 9705268178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 06/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 48066 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 5842A | WY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 20108 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 4071 | SD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 041374 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1700975570 | 05 | WY | MEDICAID | 68153767 | 05 | CO | MEDICAID |