=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306064670
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAYMOND MICHAEL DROBY PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5TH & DIVISION
-----------------------------------------------------
City | NOME
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-443-3355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1003 EAST FIRST AVE
-----------------------------------------------------
City | NOME
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99762-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-443-3355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 546
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1683-057
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------