Provider Demographics
NPI:1073866232
Name:ANGELA L DRURY PC
Entity Type:Organization
Organization Name:ANGELA L DRURY PC
Other - Org Name:ANGELA L DRURY SCHIMBERG DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRURY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-382-0773
Mailing Address - Street 1:101 HOSPTIAL LOOP NE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2129
Mailing Address - Country:US
Mailing Address - Phone:505-883-6600
Mailing Address - Fax:505-883-0023
Practice Address - Street 1:2312 WESTERN TRAILS
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1642
Practice Address - Country:US
Practice Address - Phone:512-382-0773
Practice Address - Fax:512-382-0072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELA L DRURY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1876213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T82006Medicare UPIN
TXB161821Medicare PIN