Healthcare Provider Details

I. General information

NPI: 1508077355
Provider Name (Legal Business Name): DR. MARC DRAEGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 E FIR AVE SUITE 104
FRESNO CA
93720-3808
US

IV. Provider business mailing address

1867 E FIR AVE SUITE 104
FRESNO CA
93720-3808
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-5809
  • Fax: 559-325-5838
Mailing address:
  • Phone: 559-325-5809
  • Fax: 559-325-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA115013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: