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Individual
JOHN RICHARD LAKE
Active
Individual
JOHN RICHARD LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
40739
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03G121LA
BCBS
MN
05
—
0506741
—
IA
01
—
1017135
PREFERRED ONE
MN
01
—
114843
FAIRVIEW
MN
01
—
124409
UCARE
MN
01
—
29-00011
MEDICA-PRIMARY
MN
01
—
2900020
MEDICA-CHOICE
MN
05
—
32420100
—
WI
05
—
480019200
—
MN
01
—
784417
ARAZ
—
01
—
HP28838
HEALTH PARTNERS
MN
Enumeration date
10/16/2006
Last updated
10/26/2012
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