Basic Information
| Provider Information | |||||||||
| NPI: | 1316225295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRAPER | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 505164 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631505164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554207900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1965 S FREMONT AVE STE 230 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658042258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178207250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 2086S0102X | 2013006316 | MO | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 2013006316 | MO | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | AR | MEDICAID | PENDING | 01 | MEDICARE | OTHER | PENDING | 05 | MO | MEDICAID | PENDING | 05 | OK | MEDICAID |