Individual
DR. MARK ANTHONY DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
10012 KENNERLY RD, SUITE 406, SAINT LOUIS, MO 63128-2197
(314) 525-1224
Mailing address
10012 KENNERLY RD, STE 406, SAINT LOUIS, MO 63128-2197
(314) 525-1224
(314) 525-4957
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2007006286
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205471600
—
MO
01
—
P00432176
RAILROAD MEDICARE
MO
Enumeration date
03/19/2007
Last updated
03/14/2017
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