Organization
FAMILY MEDICAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN L DRAKE D.O. (PARTNER)
(208) 414-1124
Entity
Organization
Contact information
Practice address
360 E LIBERTY ST, WEISER, ID 83672-2261
(208) 414-1124
(208) 414-0947
Mailing address
360 E LIBERTY ST, WEISER, ID 83672-2261
(208) 414-1124
(208) 414-0947
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1369418
MEDICARE PART B
ID
05
—
8006347400
—
ID
01
—
R135455
MEDICARE PART B
OR
Enumeration date
06/11/2006
Last updated
02/27/2008
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