Healthcare Provider Details

I. General information

NPI: 1841969276
Provider Name (Legal Business Name): DANIEL DAVIS DRAKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAGLE CREST DR
RANGELY CO
81648-3105
US

IV. Provider business mailing address

225 EAGLE CREST DR
RANGELY CO
81648-3105
US

V. Phone/Fax

Practice location:
  • Phone: 970-675-4205
  • Fax: 970-675-4270
Mailing address:
  • Phone: 970-675-4205
  • Fax: 970-675-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPTA.0013794
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: