Provider Demographics
NPI:1821076035
Name:DRYDEN, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:DRYDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:DRYDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5500 KELL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1612
Mailing Address - Country:US
Mailing Address - Phone:940-689-8765
Mailing Address - Fax:940-689-8769
Practice Address - Street 1:5500 KELL
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1612
Practice Address - Country:US
Practice Address - Phone:940-689-8765
Practice Address - Fax:940-689-8769
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8446208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AT661OtherBLUE CROSS & BLUE SHIELD
TXP00474272OtherRAILROAD MEDICARE
TX0243510001OtherMEDICARE DME, PALMETTO
TX103595803Medicaid
TX8K2820Medicare PIN