Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101055518 | VA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | D0042188 | MD |
N | 2081P2900X | Pain Medicine | 0101055518 | VA |
Y | 2081P2900X | Pain Medicine | D0042188 | MD |
N | 2081P2900X | Pain Medicine | MD20498 | DC |
NPI | 1174613327 |
---|---|
Provider Name | Dr. George Hudson Drakes |
First Address | Oxon Hill, MD 20745-3113 |
Second Address | Oxon Hill, MD 20745-3113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 15/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
168621600 | (05) | MD |
DD2519 | MEDICARE RAILROAD # (01) | MD |
E54745 | (02) | MD |