Lake, Brian Matthew

Lake, Brian Matthew is an sole proprietor health care provider with primary practice located at 13123 66Th St , Largo FL 33773-1812. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism. Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism is his primary health care specialty. Lake, Brian Matthew can be contacted via phone (727) 477-1039.

Contact Information

Primary practice address
13123 66Th St Largo FL 33773-1812
Phone: (727) 477-1039
Fax: (727) 477-0498
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X OS9591 Florida
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 1056 South Carolina
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X OS9591 Florida

Profile Details

NPI number 1295887040
LBN Legal business name Lake, Brian Matthew
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 18th, 2007
Last updated May 2nd, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295887040 NPPES
Florida MEDICAID 106202000
Florida Other P00756358

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