Individual
DR. DAVID THEO LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
129 N WASHINGTON ST, SUMTER, SC 29150-4949
(803) 774-9680
(803) 434-3955
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
85514
SC
208M00000X
Hospitalist Physician
Primary
85514
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
855140
—
SC
Enumeration date
03/28/2017
Last updated
06/23/2025
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