Provider Demographics
NPI:1093939464
Name:DRAPER, EDWARD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALAN
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 1:8599 W VICTORY RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-4172
Mailing Address - Country:US
Mailing Address - Phone:208-362-0611
Mailing Address - Fax:208-362-0066
Practice Address - Street 1:8599 W VICTORY RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-4172
Practice Address - Country:US
Practice Address - Phone:208-362-0611
Practice Address - Fax:208-362-0066
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-3104207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine