Provider Demographics
NPI:1194788778
Name:DRURY, BERNARD J (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:J
Last Name:DRURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2961 SUMMIT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3482
Mailing Address - Country:US
Mailing Address - Phone:510-465-0941
Mailing Address - Fax:510-465-0941
Practice Address - Street 1:2961 SUMMIT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3482
Practice Address - Country:US
Practice Address - Phone:510-465-0941
Practice Address - Fax:510-465-0941
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58175207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA011104OtherHILL PHYSICIANS
CA00G581750Medicaid
CAG58175OtherALTA BATES MEDICAL GROUP
F14391Medicare UPIN
CA011104OtherHILL PHYSICIANS