Provider Demographics
NPI:1528151685
Name:DRAKE, ROBERT G JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:DRAKE
Suffix:JR
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 1:79 IMAGING DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2869
Mailing Address - Country:US
Mailing Address - Phone:606-679-1449
Mailing Address - Fax:606-676-0048
Practice Address - Street 1:79 IMAGING DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2869
Practice Address - Country:US
Practice Address - Phone:606-679-1449
Practice Address - Fax:606-676-0048
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine