Individual
MR. RONALD LAKE II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.HT.
Contact information
Practice address
807 LIZZARD LN, PRESCOTT, AZ 86303-4517
(800) 541-9928
Mailing address
807 LIZZARD LN, PRESCOTT, AZ 86303-4517
(800) 541-9928
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11388927
CA
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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