MEDICARE: DR. WILLIAM K DRAKE MD

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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	R3047	MO
2	207ZC0006X	Clinical Pathology Physician	R3047	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0006000411	OTHER	IL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801880976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM K DRAKE MD

Provider Business Mailing Address
First Line	:	150 CARONDELET PLZ UNIT 2301
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3455
Country	:	US
Telephone Number	:	618-887-9720
Fax Number	:	618-887-4830

Provider Business Practice Location Address
First Line	:	150 CARONDELET PLZ UNIT 2301
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3455
Country	:	US
Telephone Number	:	618-887-9720
Fax Number	:

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	01/23/2025

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