Lake, Gordon Avery
Lake, Gordon Avery is an sole proprietor health care provider with primary practice located at 350 30Th Street, Suite 407 , Oakland CA 94609. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adult Medicine, which is considered as his primary health care specialty. Lake, Gordon Avery can be contacted via phone (510) 419-0230.Contact Information
Primary practice address
350 30Th Street, Suite 407
Oakland CA 94609
Phone: (510) 419-0230
Fax: (510) 419-0273
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Adult Medicine | 207QA0505X | G22921 | California |
Profile Details
| NPI number | 1356379838 |
|---|---|
| LBN Legal business name | Lake, Gordon Avery |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 30th, 2006 |
| Last updated | Jan 19th, 2016 - about 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1356379838 | NPPES |
| California | MEDICAID | 00G229210 |
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