Provider Demographics
NPI:1295730281
Name:DRAKE, ALAN ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ROSS
Last Name:DRAKE
Suffix:
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 1:2300 MONTEREY HWY
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-7600
Mailing Address - Country:US
Mailing Address - Phone:931-738-8028
Mailing Address - Fax:
Practice Address - Street 1:287 W TURN TABLE RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1366
Practice Address - Country:US
Practice Address - Phone:931-836-3262
Practice Address - Fax:931-836-3269
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000016257207Q00000X
TN16257208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3014532Medicaid
SD10075887Medicaid
TN2001672OtherBLUE CROSS ID #
TN3014532Medicaid
TNTN0101Medicare ID - Type UnspecifiedAMERICHOICE
A97848Medicare UPIN