Dr David J Drake, MD | |
25828 Redlands Blvd Ste 102, Redlands, CA 92373-8451 | |
(909) 558-6526 | |
Not Available |
Full Name | Dr David J Drake |
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Gender | Male |
Speciality | Family Medicine |
Location | 25828 Redlands Blvd Ste 102, Redlands, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1205941481 | NPI | - | NPPES |
40447-20 | Other | WI | LICENSE |
1205941481 | Medicaid | WI | |
C166230 | Other | CA | MEDICAL LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 40447 (Wisconsin) | Secondary |
207Q00000X | Family Medicine | C166230 (California) | Primary |
Entity Name | Ascension Medical Group-southeast Wisconsin Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1609881077 PECOS PAC ID: 8628980943 Enrollment ID: O20031104000421 |
Mailing Address | Practice Location Address |
---|---|
Dr David J Drake, MD File # 54701, Los Angeles, CA 90074-4701 Ph: (909) 558-6600 | Dr David J Drake, MD 25828 Redlands Blvd Ste 102, Redlands, CA 92373-8451 Ph: (909) 558-6526 |
Salma Mohammadi Green, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 245 Terracina Blvd Ste 102, Redlands, CA 92373 Phone: 909-792-2605 | |
Dr. Katrina Carter, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 1600 E Citrus Ave, Redlands, CA 92374 Phone: 909-794-3682 | |
Calvin G Hagglov, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 25828 Redlands Blvd Ste 102, Redlands, CA 92373 Phone: 909-558-6600 | |
Grace Marie Hecker, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 1910 Orange Tree Ln Ste 344, Redlands, CA 92374 Phone: 909-792-1388 Fax: 097-487-9259 | |
Shantharam Pai, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 2 W Fern Ave, Redlands, CA 92373 Phone: 909-799-7111 | |
Dr. Veena Mysore, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 25828 Redlands Blvd Ste 102, Redlands, CA 92373 Phone: 909-558-6600 | |
Horst R Rudrich, D.O. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 255 Terracina Blvd, Ste. 105, Redlands, CA 92373 Phone: 909-793-0323 Fax: 909-793-9173 |