Provider Demographics
NPI:1821015512
Name:SHARON B. DRAGER, MD, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SHARON B. DRAGER, MD, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:DRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-237-7728
Mailing Address - Street 1:2089 VALE RD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3847
Mailing Address - Country:US
Mailing Address - Phone:510-237-7728
Mailing Address - Fax:510-237-8952
Practice Address - Street 1:2089 VALE RD
Practice Address - Street 2:SUITE 23
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3847
Practice Address - Country:US
Practice Address - Phone:510-237-7728
Practice Address - Fax:510-237-8952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG312812086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G312810Medicaid
CA00G312810Medicare ID - Type Unspecified
CA00G312810Medicaid