Individual
DR. GLEN B. DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 847408, DALLAS, TX 75284-7408
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
E4305
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
807460
BLUE SHIELD
TX
Enumeration date
03/24/2006
Last updated
07/10/2007
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