Provider Demographics
NPI:1134524366
Name:PATRICIA J. DURY MD, PA
Entity type:Organization
Organization Name:PATRICIA J. DURY MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-826-8771
Mailing Address - Street 1:PO BOX 150207
Mailing Address - Street 2:SUITE # 202
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33915-0207
Mailing Address - Country:US
Mailing Address - Phone:239-945-5015
Mailing Address - Fax:239-945-5017
Practice Address - Street 1:1425 VISCAYA PKWY
Practice Address - Street 2:SUITE # 202
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3294
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:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70701207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379778300Medicaid
FL379778300Medicaid