Provider Demographics
NPI:1841542396
Name:DR. CODY DRAKE PA
Entity type:Organization
Organization Name:DR. CODY DRAKE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:276-632-5280
Mailing Address - Street 1:15 CLEVELAND AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2937
Mailing Address - Country:US
Mailing Address - Phone:276-632-5280
Mailing Address - Fax:276-632-5257
Practice Address - Street 1:107 W DECATUR ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1907
Practice Address - Country:US
Practice Address - Phone:276-632-5280
Practice Address - Fax:276-632-5257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty