Individual
JEREMY M LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 SE 7TH AVE STE 5200, HILLSBORO, OR 97123-4182
(503) 681-4310
(503) 681-1989
Mailing address
1400 SW 5TH AVE STE 500, PORTLAND, OR 97201-5537
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD24736
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183065
—
OR
Enumeration date
11/15/2005
Last updated
03/12/2026
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