Healthcare Provider Details

I. General information

NPI: 1861518383
Provider Name (Legal Business Name): LAWRENCE A DRAPER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 VANDALIA ST
COLLINSVILLE IL
62234-4061
US

IV. Provider business mailing address

2544 EIDMANN RD
BELLEVILLE IL
62221-7701
US

V. Phone/Fax

Practice location:
  • Phone: 618-344-0090
  • Fax: 618-344-4371
Mailing address:
  • Phone: 618-566-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: