Individual
ANNA LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 UNIVERSITY OF NEW MEXICO, MSC06 3870, ALBUQUERQUE, NM 87131-0001
(505) 277-3136
(505) 277-2020
Mailing address
1 UNIVERSITY OF NEW MEXICO, MSC06 3870, ALBUQUERQUE, NM 87131-0001
(505) 277-3136
(505) 277-2020
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
91236
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20007
—
NM
Enumeration date
12/02/2005
Last updated
11/08/2016
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