Provider Demographics
NPI:1407235583
Name:DRAKE FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:DRAKE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-284-0416
Mailing Address - Street 1:PO BOX 2221
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34133-2221
Mailing Address - Country:US
Mailing Address - Phone:239-949-6888
Mailing Address - Fax:239-949-0984
Practice Address - Street 1:9143 BRENDAN PRESERVE CT
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4376
Practice Address - Country:US
Practice Address - Phone:239-949-6888
Practice Address - Fax:239-949-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty