Provider Demographics
NPI:1962438069
Name:DRAWBERT, JOHN PAUL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:DRAWBERT
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 1:1200 OAKLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2245
Mailing Address - Country:US
Mailing Address - Phone:715-832-1400
Mailing Address - Fax:715-832-4187
Practice Address - Street 1:1200 OAKLEAF WAY
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2245
Practice Address - Country:US
Practice Address - Phone:715-832-1400
Practice Address - Fax:715-832-4187
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27963207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI137265200OtherOWCP
WI378L3DROtherBCBS MN
WI4360918OtherAETNA
WI09 13770OtherMEDICA/SELECTCARE CF
WI17456OtherSECURITY HEALTH PLAN
WI30761500Medicaid
WI605099OtherUNITED HEALTHCARE
WI09 13769OtherMEDICA/SELECTCARE EC
WIP00140236OtherRAILROAD
WIB52515Medicare UPIN
WI605099OtherUNITED HEALTHCARE
WI4360918OtherAETNA
WI401320001Medicare NSC