Individual
JOSEPH ROBERT LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-8010
Mailing address
504 CLINTON CENTER DRIVE, CBO SUITE 4300, CLINTON, MS 39056
(601) 815-2005
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
31395
MS
Other
Enumeration date
04/01/2020
Last updated
09/15/2023
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