Provider Demographics
NPI:1457388134
Name:DRAEGER, ROBERT EARL (CPOLPO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
Last Name:DRAEGER
Suffix:
Gender:M
Credentials:CPOLPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 LAKE FRONT CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2811
Mailing Address - Country:US
Mailing Address - Phone:409-771-3461
Mailing Address - Fax:
Practice Address - Street 1:904 POST OFFICE ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-5121
Practice Address - Country:US
Practice Address - Phone:409-763-0001
Practice Address - Fax:409-763-0012
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management