Individual
JOHN T LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
60 DOCTORS PARK LOWR LEVEL, CAPE GIRARDEAU, MO 63703
(573) 519-4949
(573) 519-4665
Mailing address
60 DOCTORS PARK LOWR LEVEL, CAPE GIRARDEAU, MO 63703-4928
(573) 519-4949
(573) 519-4665
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
108382
MO
Other
Enumeration date
06/05/2007
Last updated
08/01/2018
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