Provider Demographics
NPI:1952336554
Name:DRAPER, RICHARD EUGENE (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EUGENE
Last Name:DRAPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SUELLEN DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2725
Mailing Address - Country:US
Mailing Address - Phone:573-795-0497
Mailing Address - Fax:314-228-0050
Practice Address - Street 1:20 SUELLEN DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2725
Practice Address - Country:US
Practice Address - Phone:573-795-0497
Practice Address - Fax:314-228-0050
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4C22207P00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241730563Medicaid
MO1952336554Medicaid
MOR4C22OtherMO. PHYSICIAN LICENSE
MOR4C22OtherMO. PHYSICIAN LICENSE
MO1952336554Medicaid
MO132300580Medicare PIN
MO602630038Medicare PIN