Gordon Avery Lake
Family Doctor - Adult Medicine
350 30th Street, Suite 407
Oakland
, California 94609
Gordon Avery Lake
Family Doctor - Adult Medicine
350 30th Street, Suite 407
Oakland
, California 94609
(510) 419-0273
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About
Features
Specialties
- Family Doctor - Adult Medicine
Languages spoken
- English
Location
First Address
- Gordon Avery Lake
- 350 30th Street, Suite 407
- Oakland, CA
- Zip : 94609
- Fax : (510) 419-0273
- Phone : (510) 419-0230
Second Address
- Gordon Avery Lake
- 350 30th Street, Suite 407
- Oakland, CA
- Zip : 94609
- Fax : (510) 419-0273
- Phone : (510) 419-0230
Reviews
FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QA0505X | Family Doctor - Adult Medicine | G22921 | CA |
National Provider Identifier
| NPI | 1356379838 |
|---|---|
| Provider Name | Gordon Avery Lake |
| First Address | Oakland, CA 94609 |
| Second Address | Oakland, CA 94609 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/06/2006 |
| Last Update Date | 19/01/2016 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00G229210 | (05) | CA |
| A41775 | (02) | CA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.