Provider Demographics
NPI:1700975570
Name:DRURY, JOHN H (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
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 1:1405 S 8TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4563
Mailing Address - Country:US
Mailing Address - Phone:970-526-8181
Mailing Address - Fax:970-526-8178
Practice Address - Street 1:1405 S 8TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4563
Practice Address - Country:US
Practice Address - Phone:970-526-8181
Practice Address - Fax:970-526-8178
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48066207RC0000X
WY5842A207RC0000X
NE20108207RC0000X
SD4071207RC0000X
CT041374207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1700975570Medicaid
CO68153767Medicaid
WY1700975570Medicaid
F08737Medicare UPIN
CO68153767Medicaid