Provider Demographics
NPI:1053328773
Name:DRAPER, JOHN ALLISON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLISON
Last Name:DRAPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MEDICAL COURT
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:304-263-0953
Mailing Address - Fax:304-263-5826
Practice Address - Street 1:309 MEDICAL COURT
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-263-0953
Practice Address - Fax:304-263-5826
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13815207X00000X
MDD0058044207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV86345OtherUNICARE
VA002829OtherBCBS VA
WV000053710OtherBCBS WV
MD50778001OtherBCBS MD
T9560001OtherBLUE CHOICE
WV0099341000Medicaid
46065OtherOPTIMA HEALTH
WV86345OtherUNICARE
A72862Medicare UPIN