Individual
GEORGE BLAINE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 WILLOW PLZ, 201, VISALIA, CA 93291-6206
(559) 627-9284
(559) 713-0965
Mailing address
100 WILLOW PLZ, 201, VISALIA, CA 93291-6206
(559) 627-9284
(559) 713-0965
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
G86776
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0067850
—
CA
Enumeration date
05/17/2006
Last updated
09/27/2013
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