Provider Demographics
NPI:1154481273
Name:DAVID E DRAKE DO PC
Entity Type:Organization
Organization Name:DAVID E DRAKE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-288-8000
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1221 CENTER
Practice Address - Street 2:#3
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1014
Practice Address - Country:US
Practice Address - Phone:515-288-8000
Practice Address - Fax:515-288-4073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA029082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1154481273OtherWELLMARK BCBS
IA1154481273Medicaid
IADP1972OtherRR MEDICARE
IA2121004Medicaid
IA1154481273Medicaid
IAI3011Medicare PIN