Provider Demographics
NPI:1942568480
Name:PATRICIA J DURY MD PA INC
Entity Type:Organization
Organization Name:PATRICIA J DURY MD PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-945-5015
Mailing Address - Street 1:1708 CAPE CORAL PKWY W
Mailing Address - Street 2:SUITE 13
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6985
Mailing Address - Country:US
Mailing Address - Phone:239-945-5015
Mailing Address - Fax:239-945-5017
Practice Address - Street 1:1708 CAPE CORAL PARKWAY W
Practice Address - Street 2:SUITE 13
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914
Practice Address - Country:US
Practice Address - Phone:239-945-5015
Practice Address - Fax:239-945-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379778300Medicaid
FL379778300Medicaid