Healthcare Provider Details

I. General information

NPI: 1245299395
Provider Name (Legal Business Name): DAVID E DRAKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 VILLAGE DR
PAGOSA SPRINGS CO
81147-8368
US

IV. Provider business mailing address

185 SUTTLE ST
DURANGO CO
81303-8276
US

V. Phone/Fax

Practice location:
  • Phone: 970-264-2104
  • Fax: 970-264-2108
Mailing address:
  • Phone: 970-335-2232
  • Fax: 970-565-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number02908
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0054066
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: