Provider Demographics
NPI:1245228931
Name:DREWRY, MARCIA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:ANN
Last Name:DREWRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 STATE ROAD 415
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6012
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-322-8725
Practice Address - Street 1:2400 STATE ROAD 415
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-6012
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:407-322-8725
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01123229OtherAMERIGROUP
FL271338100Medicaid
FL289273OtherWELLCARE
FL46003OtherBC/BS
FL289273OtherWELLCARE
FL271338100Medicaid