Provider Demographics
NPI:1992722490
Name:DRAKE, STANLEY R (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:R
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 1:525 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4303
Mailing Address - Country:US
Mailing Address - Phone:812-232-6613
Mailing Address - Fax:812-234-3988
Practice Address - Street 1:525 S 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-4303
Practice Address - Country:US
Practice Address - Phone:812-232-6613
Practice Address - Fax:812-234-3988
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038450A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100252390AMedicaid
IN248460AMedicare PIN
IN100252390AMedicaid