Provider Demographics
NPI:1346257771
Name:DRAKE, SABRA F (MD)
Entity Type:Individual
Prefix:DR
First Name:SABRA
Middle Name:F
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 1:176 GOODMAN RD W
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9405
Mailing Address - Country:US
Mailing Address - Phone:662-536-1020
Mailing Address - Fax:662-510-6992
Practice Address - Street 1:176 GOODMAN RD W
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9405
Practice Address - Country:US
Practice Address - Phone:662-536-1020
Practice Address - Fax:662-510-6992
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD019355207R00000X
ARE4977207R00000X
MS20330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4087567OtherBLUE CROSS OF TN
TN3884413Medicaid
AR57941OtherBCBS OF AR
AR163881001Medicaid
AR163881001Medicaid
AR5N714Medicare PIN
TN3370244Medicare PIN
302I114979Medicare PIN
AR57941OtherBCBS OF AR
TN4087567OtherBLUE CROSS OF TN