=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962438069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN PAUL DRAWBERT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 01/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 OAKLEAF WAY
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54720-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-832-1400
-----------------------------------------------------
Fax | 715-832-4187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 OAKLEAF WAY
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54720-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-832-1400
-----------------------------------------------------
Fax | 715-832-4187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 27963
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------