Provider Demographics
NPI:1194951707
Name:DRACHENBERG, ANNIE SPROTT (MD)
Entity type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:SPROTT
Last Name:DRACHENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:LAYNE
Other - Last Name:DRACHENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1441 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3534
Mailing Address - Country:US
Mailing Address - Phone:325-672-3252
Mailing Address - Fax:
Practice Address - Street 1:1441 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3534
Practice Address - Country:US
Practice Address - Phone:325-672-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071948A207Q00000X
TXP0577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX353060201Medicaid
TX353060201Medicaid
TX459010YMJMMedicare PIN
TX353060201Medicaid