Provider Demographics
NPI:1467476242
Name:WOODSON, DRURY L (MD)
Entity Type:Individual
Prefix:DR
First Name:DRURY
Middle Name:L
Last Name:WOODSON
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:PO BOX 1263
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-1263
Mailing Address - Country:US
Mailing Address - Phone:409-933-0733
Mailing Address - Fax:409-933-9777
Practice Address - Street 1:622 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-5936
Practice Address - Country:US
Practice Address - Phone:409-933-0733
Practice Address - Fax:409-933-9777
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080803201Medicaid
TX0053KDOtherBLUE CROSS AND BLUE SHIEL
TXC23758Medicare UPIN
TX080803201Medicaid