Provider Demographics
NPI:1861853236
Name:IMRIE, DRU (MD/PHD)
Entity type:Individual
Prefix:
First Name:DRU
Middle Name:
Last Name:IMRIE
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7976
Mailing Address - Country:US
Mailing Address - Phone:951-765-1777
Mailing Address - Fax:951-765-1772
Practice Address - Street 1:1285 S STATE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7976
Practice Address - Country:US
Practice Address - Phone:951-765-1777
Practice Address - Fax:951-765-1772
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1488822080N0001X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program