MEDICARE: STEPHEN S DRAPER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	17955	KY
2	207Q00000X	Family Medicine Physician	17955	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619974805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN S DRAPER M.D.

Provider Business Mailing Address
First Line	:	100 E LIBERTY ST
Second Line	:	SUITE 800
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1434
Country	:	US
Telephone Number	:	859-885-9402
Fax Number	:	859-887-1624

Provider Business Practice Location Address
First Line	:	1250 KEENE RD
Second Line	:	SUITE 102
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-7600
Country	:	US
Telephone Number	:	859-885-9402
Fax Number	:	859-887-1624

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/18/2015

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