Provider Demographics
NPI:1760405468
Name:DRIESBACH, DAVID R (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:DRIESBACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 KENSINGTON HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-5648
Mailing Address - Country:US
Mailing Address - Phone:941-213-0094
Mailing Address - Fax:
Practice Address - Street 1:643 CAPE CORAL PKWY E
Practice Address - Street 2:SUITE F
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8549
Practice Address - Country:US
Practice Address - Phone:239-540-4500
Practice Address - Fax:239-540-1952
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS00006995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL192325OtherSTAYWELL HEALTHYKIDS
FL1188691OtherCIGNA HMO
FL57245OtherBCBS PROVIDER NUMBER
FLOS00006995OtherLICENSE
FLOS00006995OtherLICENSE
FL57245BMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
FL57245OtherBCBS PROVIDER NUMBER
FL1188691OtherCIGNA HMO