Provider Demographics
NPI:1689739039
Name:DRAKE, CLAYTON FRANKLYN JR (MD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:FRANKLYN
Last Name:DRAKE
Suffix:JR
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 1:430 W NAPA ST STE F
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6545
Mailing Address - Country:US
Mailing Address - Phone:707-939-6070
Mailing Address - Fax:707-939-6077
Practice Address - Street 1:430 W NAPA ST STE F
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6545
Practice Address - Country:US
Practice Address - Phone:707-939-6070
Practice Address - Fax:707-939-6077
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33725Medicare UPIN