Individual
JASON MICHAEL LAKE
Active
Individual
JASON MICHAEL LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
01055969A
IN
207RG0100X
Gastroenterology Physician
Primary
MD60197811
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0284329
L&I
WA
05
—
1225133820
—
WA
01
—
P01082412
RR MEDICARE
WA
Enumeration date
09/14/2006
Last updated
08/09/2013
Update your record
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