Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 15905 | NC |
NPI | 1063731487 |
---|---|
Provider Name | Dr. James Edwin Drake |
First Address | Myrtle Beach, SC 29578-3099 |
Second Address | New Bern, NC 28562-5238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2010 |
Last Update Date | 21/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C83566 | (02) |