Provider Demographics
NPI:1164416624
Name:DRAVES, EARL GENE (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:GENE
Last Name:DRAVES
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 1:1471 US HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4109
Mailing Address - Country:US
Mailing Address - Phone:636-937-2700
Mailing Address - Fax:
Practice Address - Street 1:1471 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:636-937-2700
Practice Address - Fax:636-937-8666
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD103429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS080102341OtherR.R. MEDICARE
MO208290403Medicaid
MS080102341OtherR.R. MEDICARE