Individual
DR. DOUGLAS R. LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1215 DUFF AVENUE, AMES, IA 50010-3014
(515) 239-4456
(515) 239-4761
Mailing address
PO BOX 3014, 1215 DUFF AVENUE, AMES, IA 50010-3014
(515) 239-4456
(515) 239-4761
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
23902
SC
2085R0202X
Diagnostic Radiology Physician
24188
NE
2085R0202X
Diagnostic Radiology Physician
Primary
37861
IA
2085R0202X
Diagnostic Radiology Physician
A99351
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01626
BC/BS NE
—
05
—
10025173600
—
NE
05
—
10025186700
—
NE
05
—
10025248800
—
NE
05
—
1194808394
—
IA
01
—
200145166
WELLMARK SELECT FIRST
IA
01
—
201477608
WELLMARK SELECT FIRST
IA
01
—
34783
BC/BS NE
—
05
—
69958751
—
CO
05
—
7729430
—
SD
01
—
P00619095
RR MEDICARE
IA
01
—
P00619099
RR MEDICARE
NE
Enumeration date
10/23/2006
Last updated
11/03/2020
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