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Individual

ANGEL ANTHONY LAKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4007 DIAMOND RUBY, CHRISTIANSTED, VI 00820
(340) 778-6311
Mailing address
PO BOX 371, CHRISTIANSTED, VI 00821-0371
(340) 778-5989

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1365
VI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1365
VI LIC NUMBER
VI
Enumeration date
02/13/2007
Last updated
08/26/2010
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