Healthcare Provider Details

I. General information

NPI: 1689701492
Provider Name (Legal Business Name): JAMES ROLLIN DRAEGER L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 VILLA RD
NEWBERG OR
97132-1855
US

IV. Provider business mailing address

430 VILLA RD
NEWBERG OR
97132-1855
US

V. Phone/Fax

Practice location:
  • Phone: 971-275-3787
  • Fax: 503-491-0462
Mailing address:
  • Phone: 971-275-3787
  • Fax: 503-491-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCO 998
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: