MEDICARE: DR. BYRON DRAKE ERSTINE D.O.

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	A-1900-15	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487847174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYRON DRAKE ERSTINE D.O.

Provider Business Mailing Address
First Line	:	1620 N MAIN ST
Second Line	:
City	:	SPANISH FORK
State	:	UT
Zip	:	84660-1008
Country	:	US
Telephone Number	:	801-822-2234
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 HILLRISE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4701
Country	:	US
Telephone Number	:	575-449-8949
Fax Number	:

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

Provider Enumeration Date	:	08/25/2007
Last Update Date	:	02/02/2021

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