Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | ME135482 | FL |
NPI | 1023379575 |
---|---|
Provider Name | Nicholas M Drake |
First Address | Pensacola, FL 32522-7567 |
Second Address | Pensacola, FL 32501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 31/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025013000 | (05) | FL |