Individual
DR. BRAD M LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15770 PAUL VEGA MD DR STE 204, HAMMOND, LA 70403-1475
(985) 230-7860
(985) 230-7861
Mailing address
PO BOX 2668, HAMMOND, LA 70404-2668
(985) 230-7860
(985) 230-7861
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD.205375
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2301853
—
LA
Enumeration date
06/29/2007
Last updated
12/09/2022
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