Provider Demographics
NPI:1114986254
Name:DRAKE, CASEY ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ELLEN
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E INTERSTATE 30 STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5402
Mailing Address - Country:US
Mailing Address - Phone:214-912-1531
Mailing Address - Fax:214-520-7120
Practice Address - Street 1:201 E INTERSTATE 30 STE 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5402
Practice Address - Country:US
Practice Address - Phone:214-912-1531
Practice Address - Fax:469-757-4890
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9870208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152476101Medicaid
TX8444B7Medicare ID - Type Unspecified