Healthcare Provider Details

I. General information

NPI: 1952336554
Provider Name (Legal Business Name): RICHARD EUGENE DRAPER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 OAK GROVE RD
POPLAR BLUFF MO
63901-1573
US

IV. Provider business mailing address

10456 KNOB NOSTER RD
KNOB NOSTER MO
65336-3105
US

V. Phone/Fax

Practice location:
  • Phone: 573-776-2000
  • Fax:
Mailing address:
  • Phone: 189-771-5529
  • Fax: 573-240-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberR4C22
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberR4C22
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR4C22
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: