Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D10812 | OR |
NPI | 1063998730 |
---|---|
Provider Name | Dr. Donald Ray Draper |
First Address | Idaho Falls, ID 83402-5752 |
Second Address | Grants Pass, OR 97526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2018 |
Last Update Date | 26/07/2018 |