Provider Demographics
NPI:1104889641
Name:DRAKE, WILLIAM NEIL (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:NEIL
Last Name:DRAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 FOUNDERS WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5435
Mailing Address - Country:US
Mailing Address - Phone:817-741-8355
Mailing Address - Fax:
Practice Address - Street 1:10900 FOUNDERS WAY STE 103
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5435
Practice Address - Country:US
Practice Address - Phone:817-741-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF91045Medicare UPIN
TX88300NMedicare ID - Type Unspecified