MEDICARE: DR. EDMUND W DRAPER 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	207Q00000X	Family Medicine Physician	38159	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	383R9DR	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1396758470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDMUND W DRAPER M.D.

Provider Business Mailing Address
First Line	:	3920 13TH AVE E
Second Line	:	SUITE 6
City	:	HIBBING
State	:	MN
Zip	:	55746-3675
Country	:	US
Telephone Number	:	218-263-7540
Fax Number	:	866-732-0699

Provider Business Practice Location Address
First Line	:	239 MCKINLEY AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1606
Country	:	US
Telephone Number	:	218-744-3472
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	04/18/2008

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