Provider Demographics
NPI:1487975975
Name:DRURY, BRADLEY ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ROBERT
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 1:13555 KILTIE CT
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3624
Mailing Address - Country:US
Mailing Address - Phone:502-418-0744
Mailing Address - Fax:
Practice Address - Street 1:14255 SW 42ND ST # 13B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6408
Practice Address - Country:US
Practice Address - Phone:305-395-4411
Practice Address - Fax:561-645-8759
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME140319208D00000X
TNMD0000054809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103558900Medicaid