Provider Demographics
NPI:1083672083
Name:DRURY, ANGELA L (DPM)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:DRURY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LEE
Other - Last Name:DRURY SCHIMBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:2312 WESTERN TRAILS BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:512-382-0773
Mailing Address - Fax:512-382-0772
Practice Address - Street 1:2312 WESTERN TRAILS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-382-0773
Practice Address - Fax:512-382-0772
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1876213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM311347257OtherTRIWEST
NM213E00000XMedicaid
NM6475070001Medicare NSC
NM311347257OtherTRIWEST
NM$$$$$$$$$MMedicare PIN
NM6475070001Medicare NSC