Individual
JASON MICHAEL LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
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
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