Doctor Name: | JERRY W DRAKE |
NPI Number: | 1023055969 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 4301045887 |
Business Practice Address: | 840 Oakwood Blvd Dearborn, MI - 481242319 |
Business Phone Number: | 3133597650 |
Business Fax Number: | 3133597660 |
Mailing Address: | Po Box 2802, DEARBORN |
State: | MI |
Postal Code: | 481232929 |
Phone Number: | 3133597650 |
Fax Number: | 3133597660 |
NPI Enumeration Date: | 05/31/2006 |
NPI Last Update Date: | 08/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2085R0202X |
License Number: | 4301045887 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Radiology |
Taxonomy Specialization: | Diagnostic Radiology |
Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |