MEDICARE: DR. SAMUEL LEE DRAKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	C37664	CA
2	208D00000X	General Practice Physician	C37664	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C37664	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1013094341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL LEE DRAKE M.D.

Provider Business Mailing Address
First Line	:	3540 WILSHIRE BLVD
Second Line	:	SUITE 714
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2307
Country	:	US
Telephone Number	:	213-382-2063
Fax Number	:	213-382-4935

Provider Business Practice Location Address
First Line	:	3540 WILSHIRE BLVD
Second Line	:	SUITE 714
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2307
Country	:	US
Telephone Number	:	213-382-2063
Fax Number	:	213-382-4935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/07/2023

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