Provider Demographics
NPI:1184965725
Name:DRAKE, MARK (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:DRAKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:3800 J ST
Mailing Address - Street 2:200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5551
Mailing Address - Country:US
Mailing Address - Phone:916-453-8900
Mailing Address - Fax:916-454-4359
Practice Address - Street 1:5 MEDICAL PLAZA DR
Practice Address - Street 2:110
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2865
Practice Address - Country:US
Practice Address - Phone:916-782-3444
Practice Address - Fax:916-782-3490
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXT09-2012213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery