Healthcare Provider Details

I. General information

NPI: 1750472049
Provider Name (Legal Business Name): TERRANCE JOSEPH DRAKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 CASTLEWAY DR
INDIANAPOLIS IN
46250-1946
US

IV. Provider business mailing address

8003 CASTLEWAY DR
INDIANAPOLIS IN
46250-1946
US

V. Phone/Fax

Practice location:
  • Phone: 317-576-1335
  • Fax: 317-576-1339
Mailing address:
  • Phone: 317-576-1335
  • Fax: 317-576-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01036941
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: