Provider Demographics
NPI:1386615995
Name:DRAKES, THOMAS P (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:DRAKES
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 1:51 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEY SPGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252-9736
Mailing Address - Country:US
Mailing Address - Phone:209-772-7070
Mailing Address - Fax:
Practice Address - Street 1:51 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:VALLEY SPGS
Practice Address - State:CA
Practice Address - Zip Code:95252-9736
Practice Address - Country:US
Practice Address - Phone:209-772-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31160207R00000X
IDM-11010207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1386615995OtherBLUE CROSS OF IDAHO
CAG31160OtherLICENSE
IDM-11010OtherSTATE LICENSE
ID1386615995OtherBLUE CROSS OF IDAHO