1740365048 NPI number — DRAKE D DUANE MD PC

Table of content: (NPI 1740365048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740365048 NPI number — DRAKE D DUANE MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRAKE D DUANE MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1740365048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8585 E BELL RD
Provider Second Line Business Mailing Address:
SUITE 101-A
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-1303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-860-1222
Provider Business Mailing Address Fax Number:
480-860-0029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8585 E BELL RD
Provider Second Line Business Practice Location Address:
SUITE 101-A
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-860-1222
Provider Business Practice Location Address Fax Number:
480-860-0029
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUANE
Authorized Official First Name:
DRAKE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
480-860-1222

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  16903 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 276867 . This is a "AHCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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