Provider Demographics
NPI:1346348844
Name:DRURY, BRADFORD D (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:D
Last Name:DRURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 GUARDIAN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4322
Mailing Address - Country:US
Mailing Address - Phone:252-247-2101
Mailing Address - Fax:252-247-4675
Practice Address - Street 1:3714 GUARDIAN AVE STE E
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4322
Practice Address - Country:US
Practice Address - Phone:252-247-2101
Practice Address - Fax:252-247-2101
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400782208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8929192Medicaid
NC8929192Medicaid
NC2198992BMedicare PIN