Individual
DR. LADD DANIEL LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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