Healthcare Provider Details

I. General information

NPI: 1285521476
Provider Name (Legal Business Name): DRAKE DAVID LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SE DODSON RD
BENTONVILLE AR
72712-3728
US

IV. Provider business mailing address

3700 SE DODSON RD
BENTONVILLE AR
72712-3728
US

V. Phone/Fax

Practice location:
  • Phone: 479-763-3501
  • Fax: 479-763-3502
Mailing address:
  • Phone: 479-763-3501
  • Fax: 479-763-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number123498
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: