Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 07298 | MS |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 07298 | MS |
NPI | 1154349223 |
---|---|
Provider Name | Dr. John Kirk Drake |
First Address | Vancleave, MS 39565-6770 |
Second Address | Vancleave, MS 39565-6770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 22/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00117280 | (05) | MS |
D00712 | (02) |