Provider Demographics
NPI:1942248497
Name:BRAKE, DONALD R JR (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:BRAKE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 ST MARYS EPWORTH XING # A300
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9497
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 ST MARYS EPWORTH XING
Practice Address - Street 2:STE A300
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9497
Practice Address - Country:US
Practice Address - Phone:812-485-7752
Practice Address - Fax:812-485-7753
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01042288A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF65757Medicare UPIN
INF65757Medicare UPIN
IN000000485716OtherANTHEM PIN
IN237890OtherGROUP MEDICARE
KY64879158Medicaid
IN237890EMedicare PIN
IN100383720Medicaid
KY65945420OtherGROUP MEDICAID
IN200829650GOtherGROUP MEDICIAD
INDF3251OtherRAILROAD GROUP