Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Individual
JACK F LAKE
Active
Individual
JACK F LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10001841
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0186925
STATE L&I
WA
05
—
8401788
—
WA
01
—
8940030
STATE CRIME VICTIMS
WA
01
—
P00153517
RAILROAD
WA
Enumeration date
08/11/2006
Last updated
11/16/2010
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign upProduct
Developers