Provider Demographics
NPI:1609836543
Name:DRAKE, ROBERT PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:DRAKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N GILBERT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543
Mailing Address - Country:US
Mailing Address - Phone:951-652-4386
Mailing Address - Fax:951-925-4947
Practice Address - Street 1:255 N GILBERT ST
Practice Address - Street 2:SUITE B
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-652-4386
Practice Address - Fax:951-925-4947
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE26090213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E26090Medicaid
T11400Medicare UPIN
CAZZZ85609ZMedicare ID - Type Unspecified