Lake, John Russell
Lake, John Russell is an sole proprietor health care provider with primary practice located at 5565 Grossmont Center Dr Bldg 3 Suite 256, La Mesa CA 91942-3020. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Lake, John Russell can be contacted via phone (619) 462-3131.Contact Information
Primary practice address
5565 Grossmont Center Dr Bldg 3 Suite 256
La Mesa CA 91942-3020
Phone: (619) 462-3131
Fax: (619) 462-1731
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | G14553 | California |
Profile Details
| NPI number | 1568497238 |
|---|---|
| LBN Legal business name | Lake, John Russell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 11th, 2006 |
| Last updated | Jul 9th, 2007 - about 17 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 | 1568497238 | NPPES |
| Arkansas | MEDICAID | ZZZ72232Z |
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