Individual
DR. BRIAN MATTHEW LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
13123 66TH ST, LARGO, FL 33773-1812
(727) 477-1039
(727) 477-0498
Mailing address
13123 66TH ST, LARGO, FL 33773-1812
(727) 477-1039
(727) 477-0498
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
OS9591
FL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
1056
SC
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
OS9591
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106202000
—
FL
01
—
P00756358
RAILROAD MEDICARE PIN
FL
Enumeration date
01/18/2007
Last updated
05/02/2021
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