Individual
DR. LADD DANIEL LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 W LEOTA ST, NORTH PLATTE, NE 69101-6525
(308) 696-7491
(308) 696-7432
Mailing address
PO BOX 362, NORTH PLATTE, NE 69103-0362
(866) 477-7013
(866) 902-2445
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
22147
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04192
BC/BS OF NEBRASKA
NE
05
—
0585794
—
IA
05
—
10025186700
—
NE
01
—
1603089
SHARE ADVANTAGE
NE
01
—
20050
WELLMARK BC/BS
IA
01
—
243897
MIDLANDS CHOICE
NE
01
—
605082700
US DEPARTMENT OF LABOR
NE
Enumeration date
05/02/2006
Last updated
05/31/2016
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