Provider Demographics
NPI:1003510397
Name:DROKE, JOSEPH RAYMOND (LAC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:DROKE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30628 CALLE CHUECA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1602
Mailing Address - Country:US
Mailing Address - Phone:661-373-0666
Mailing Address - Fax:
Practice Address - Street 1:30628 CALLE CHUECA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1602
Practice Address - Country:US
Practice Address - Phone:661-373-0666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19577207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty