Healthcare Provider Details

I. General information

NPI: 1487847174
Provider Name (Legal Business Name): BYRON DRAKE ERSTINE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2007
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 HILLRISE DR
LAS CRUCES NM
88011-4701
US

IV. Provider business mailing address

1620 N MAIN ST
SPANISH FORK UT
84660-1008
US

V. Phone/Fax

Practice location:
  • Phone: 575-449-8949
  • Fax:
Mailing address:
  • Phone: 801-822-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA-1900-15
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: