Healthcare Provider Details

I. General information

NPI: 1164589982
Provider Name (Legal Business Name): JAMES GARL DRAKE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 N SKYLINE DR
IDAHO FALLS ID
83402-1726
US

IV. Provider business mailing address

885 PANCHERI DR
IDAHO FALLS ID
83402-3344
US

V. Phone/Fax

Practice location:
  • Phone: 208-524-0870
  • Fax: 208-524-0873
Mailing address:
  • Phone: 208-524-0870
  • Fax: 208-524-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberD-3723
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: