Provider Demographics
NPI:1942274899
Name:DRURY, BENJAMIN TODD (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TODD
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 1:2425 HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5011
Mailing Address - Country:US
Mailing Address - Phone:817-540-4477
Mailing Address - Fax:817-510-0185
Practice Address - Street 1:2425 HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5011
Practice Address - Country:US
Practice Address - Phone:817-540-4477
Practice Address - Fax:817-510-0185
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM86352086S0105X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357737101Medicaid
H18615Medicare UPIN
TX357737101Medicaid
LA5H382F735Medicare ID - Type Unspecified