# JOHN RICHARD LAKE

> 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. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1740360619
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | 40739 | MN | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 10/26/2012

## 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 |