Provider Demographics
NPI:1326036518
Name:DURY, PATRICIA J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:DURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150207
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33915-0207
Mailing Address - Country:US
Mailing Address - Phone:239-945-5015
Mailing Address - Fax:239-945-5017
Practice Address - Street 1:1003 DEL PRADO BLVD S
Practice Address - Street 2:STE 303
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3601
Practice Address - Country:US
Practice Address - Phone:239-945-5015
Practice Address - Fax:239-945-5017
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70701207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379778300Medicaid
FL31898OtherBLUE CROSS
FL379778300Medicaid