Provider Demographics
NPI:1528078144
Name:DRY, JANE (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:DRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 SHREVEPORT HWY # 113
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4044
Mailing Address - Country:US
Mailing Address - Phone:318-466-2312
Mailing Address - Fax:318-483-5077
Practice Address - Street 1:2495 SHREVEPORT HWY # 113
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4044
Practice Address - Country:US
Practice Address - Phone:318-466-2312
Practice Address - Fax:318-466-2312
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015778207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1124443Medicaid
LA1124443Medicaid
LAH68009Medicare UPIN
LA4E364Medicare PIN