Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 47457 | OH |
NPI | 1033265962 |
---|---|
Provider Name | Miles Edward Drake |
First Address | Columbus, OH 43215-5369 |
Second Address | Columbus, OH 43215-5369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |