Bryan L Drake, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0-67 Issued in ID

Practice address

360 E Liberty St
Weiser, ID 83672-2261

Phone

(208) 414-1124

Fax

(208) 414-0947

NPI assigned

Jun 15, 2006

Last updated

Feb 27, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bryan L. Drake, D.O.

  dba Family Medical Center

  • Clinic/Center
  • Weiser, ID
  • NPI 1518997345
  Authorized official Same address or phone
• Family Medical Center PLLC

  • Family Medicine Physician
  • Weiser, ID
  • NPI 1972545556
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204070400000",
    "number": "1144264011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 E LIBERTY ST",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836722261",
            "telephone_number": "208-414-1124",
            "fax_number": "208-414-0947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 E LIBERTY ST",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836722261",
            "telephone_number": "208-414-1124",
            "fax_number": "208-414-0947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAKE",
        "first_name": "BRYAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2008-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "0-67",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002695400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "135457",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "1300707",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Communicare, Inc
• Current Physical Therapy Weiser LLC
• Katrina Davis
• Damon Cole Dejulis, PHARMD
• Dille Dental, PLLC
• Shawna Eddy Eddy Kissell, PSYCHOLOGIST, LCPC
• Elemental Wellness & Chiropractic (Ewc)
• Matthew Kai Elliott, D.O.
• Ewc Weiser PLLC (Elemental Wellness and Chiropractic)
• Family Medical Center PLLC

• Family Medicine Physician in Weiser, ID
• Providers in Weiser, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.