Healthcare Provider Details

I. General information

NPI: 1164416624
Provider Name (Legal Business Name): EARL GENE DRAVES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 US HIGHWAY 61
FESTUS MO
63028
US

IV. Provider business mailing address

1471 US HIGHWAY 61
FESTUS MO
63028-4109
US

V. Phone/Fax

Practice location:
  • Phone: 636-937-2700
  • Fax: 636-937-8666
Mailing address:
  • Phone: 636-937-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD103429
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: