# LAKE ENDOCRINOLOGY AND DIABETES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Endocrinology Consulting, PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619418563
- **Authorized official:** BRIAN MATTHEW LAKE DO (AMBR)
- **Authorized official phone:** (727) 477-1039

## Contact information

- **Practice address:** 13123 66TH ST, LARGO, FL 33773-1812
- **Practice address phone:** (727) 477-1039
- **Practice address fax:** (727) 477-0498
- **Mailing address:** 13123 66TH ST, LARGO, FL 33773-1812
- **Mailing address phone:** (727) 477-1039
- **Mailing address fax:** (727) 477-0498

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | OS9591 | FL | — |

## Other

- **Enumeration date:** 03/12/2017
- **Last updated:** 05/02/2021