Healthcare Provider Details

I. General information

NPI: 1841519139
Provider Name (Legal Business Name): JAMES J DRAKE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4226 LIMESTONE TRCE
JEFFERSONVILLE IN
47130-8792
US

IV. Provider business mailing address

4226 LIMESTONE TRCE
JEFFERSONVILLE IN
47130-8792
US

V. Phone/Fax

Practice location:
  • Phone: 502-498-6309
  • Fax:
Mailing address:
  • Phone: 502-498-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: