Provider Demographics
NPI:1861518383
Name:DRAPER, LAWRENCE A (PA-C)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:A
Last Name:DRAPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 EIDMANN RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-7701
Mailing Address - Country:US
Mailing Address - Phone:618-566-8842
Mailing Address - Fax:
Practice Address - Street 1:531 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4061
Practice Address - Country:US
Practice Address - Phone:618-344-0090
Practice Address - Fax:618-344-4371
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL562620Medicare PIN