Provider Demographics
NPI:1841272168
Name:DRAPER, SHANE D (DPM)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:D
Last Name:DRAPER
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2078 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2627
Mailing Address - Country:US
Mailing Address - Phone:775-738-1100
Mailing Address - Fax:775-738-1101
Practice Address - Street 1:2078 IDAHO ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2627
Practice Address - Country:US
Practice Address - Phone:775-738-1100
Practice Address - Fax:775-738-1101
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9903213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC3776OtherBS FEDERAL EMP PROGRAM
NV480033493OtherPALMETTO RAILROAD
NVNV9903OtherBCBS OF NV
NV002104006Medicaid
NV480033493OtherPALMETTO RAILROAD
NV002104006Medicaid