Provider Demographics
NPI:1376657049
Name:DRYDEN, ROBERT MERRILL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MERRILL
Last Name:DRYDEN
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 1:1241 N WILMOT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5154
Mailing Address - Country:US
Mailing Address - Phone:520-722-0909
Mailing Address - Fax:520-722-6937
Practice Address - Street 1:1241 N WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5154
Practice Address - Country:US
Practice Address - Phone:520-722-0909
Practice Address - Fax:520-722-6937
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06151208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD43863Medicare UPIN
AZZ18WCHLD01Medicare PIN