person
Gordon Avery Lake, MD
Adult Medicine Physician in Oakland, California
NPI 1356379838

Gordon Avery Lake is an Adult Medicine Physician based in Oakland, CA and is specialized in Adult Medicine. Gordon Avery Lake practices in Oakland, CA and has the professional credentials of MD. The NPI Number for Gordon Avery Lake is 1356379838 and holds a License No. G22921 (California).

The current practice location address for Gordon Avery Lake is 350 30Th Street, Suite 407, Oakland, CA and can be reached out via phone at 510-419-0230 and via fax at 510-419-0273.

Location: 350 30Th Street, Suite 407, Oakland, CA, 94609
person
Provider Profile Details
NPI Number
1356379838
Provider Name
Gordon Avery Lake
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
350 30Th Street, Suite 407, Oakland, CA, 94609
Phone Number
510-419-0230
Fax Number
510-419-0273
Provider Enumeration Date
06/30/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00G229210 05 CA
institution
Provider Business Practice Location Address Details
Address
350 30Th Street, Suite 407
City
State
Zip
94609
Phone Number
510-419-0230
Fax Number
510-419-0273
person
Provider Business Mailing Address Details
Address
350 30Th Street, Suite 407
City
State
Zip
94609
Phone Number
510-419-0230
Fax Number
510-419-0273
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
Adult Medicine
Taxonomy
License No.
G22921 (California)
Definition
Definition to come.
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