1184601080 NPI number — DAVID F DRAKE M.D.

Table of content: DAVID F DRAKE M.D. (NPI 1184601080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184601080 NPI number — DAVID F DRAKE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRAKE
Provider First Name:
DAVID
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184601080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4380 MALSBARY RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-5644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-366-4488
Provider Business Mailing Address Fax Number:
513-366-4480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 5 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45230-2163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-232-0120
Provider Business Practice Location Address Fax Number:
513-232-8483
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  35031757 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0262540 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0641478 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 283794 . This is a "AMERIGROUP MEDICAID OH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 31757-06 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64866254 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25-20413 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311438871060 . This is a "CARESOURCE MEDICAID OH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000215208 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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