Provider Demographics
NPI:1679528319
Name:DR. CODY DRAKE'S OFFICE
Entity type:Organization
Organization Name:DR. CODY DRAKE'S OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CODY
Authorized Official - Suffix:
Authorized Official - Credentials:PODIATRY
Authorized Official - Phone:336-548-4800
Mailing Address - Street 1:107 W DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NC
Mailing Address - Zip Code:27025-1907
Mailing Address - Country:US
Mailing Address - Phone:336-548-4800
Mailing Address - Fax:336-548-4808
Practice Address - Street 1:107 W DECATUR ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1907
Practice Address - Country:US
Practice Address - Phone:336-548-4800
Practice Address - Fax:336-548-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU02680Medicare UPIN