Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 119862 | MO |
NPI | 1255389920 |
---|---|
Provider Name | Dr. William Baker Drake III |
First Address | Kansas City, MO 64116-1779 |
Second Address | Kansas City, MO 64116-1779 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 03/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
204834204 | (05) | MO |
G58761 | (02) | MO |