Individual
MARCY G LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4855 SW WESTERN AVE, BEAVERTON, OR 97005-3460
(503) 813-2000
Mailing address
4855 SW WESTERN AVE, BEAVERTON, OR 97005-3460
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO173074
OR
Other
Enumeration date
06/27/2006
Last updated
12/30/2015
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