Healthcare Provider Details

I. General information

NPI: 1053015107
Provider Name (Legal Business Name): ROBERT DRAKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RADIATION MEDICINE DEPT. C/O HANNA WEBB 535 BARNHILL DR.
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

RADIATION MEDICINE DEPT. C/O HANNA WEBB 535 BARNHILL DR.
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-1315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number01100697A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: