Basic Information
| Provider Information | |||||||||
| NPI: | 1063731487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRAKE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | EDWIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3099 | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295783099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434672676 | ||||||||
| FaxNumber: | 8434979566 | ||||||||
| Practice Location | |||||||||
| Address1: | 722 NEWMAN RD | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285625238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434672676 | ||||||||
| FaxNumber: | 8434979566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2010 | ||||||||
| LastUpdateDate: | 11/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 15905 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 15905 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085B0100X | 15905 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085D0003X | 15905 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | 2085U0001X | 15905 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085N0700X | 15905 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 15905 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | 15905 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0001X | 15905 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0205X | 15905 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Radiological Physics | 2085R0203X | 15905 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 207U00000X | 15905 | NC | N | Allopathic & Osteopathic Physicians | Nuclear Medicine |
No ID Information.