Healthcare Provider Details

I. General information

NPI: 1376767897
Provider Name (Legal Business Name): JOHN BENJAMIN DRAPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 STOCKYARD RD STE I-200
MISSOULA MT
59808-1503
US

IV. Provider business mailing address

PO BOX 17527
MISSOULA MT
59808-7527
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-8420
  • Fax: 406-541-8430
Mailing address:
  • Phone: 406-728-8420
  • Fax: 406-541-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number7734911-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMED-PHYS-LIC-40778
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMED-PHYS-LIC-40778
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD2011-0008
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: