Mick G Drage LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2585 Issued in AZ

Legal business name

MICK G DRAGE LLC

Practice address

1515 S 20TH Ave
Safford, AZ 85546-4009

Phone

(928) 348-1370

NPI assigned

Apr 29, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Micky G Drage, PA-C

Title

Business Owner

Phone

(928) 348-1370

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367193600000",
    "number": "1790120129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 S 20TH AVE",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855464009",
            "telephone_number": "928-348-1370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 S 20TH AVE",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855464009",
            "telephone_number": "928-348-1370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICK G DRAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-29",
        "last_updated": "2013-04-29",
        "status": "A",
        "authorized_official_last_name": "DRAGE",
        "authorized_official_first_name": "MICKY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "928-348-1370",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "639354",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald L McAdam, DO
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• Shayleh Moffett, WHNP
• Bradford N. Montierth, M.D

• Physician Assistant in Safford, AZ
• Providers in Safford, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2013; 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.