Gordon Avery Lake in Oakland - Adult Medicine
Gordon Avery Lake - NPI 1356379838
Gordon Avery Lake is a Adult Medicine in Oakland, California. Gordon Avery Lake practices all healthcare services and medical treatments related to Adult Medicine. The NPI Number for Gordon Avery Lake is 1356379838. The last update date is 2016-01-19.
Gordon Avery Lake's current location address is 350 30th Street, Suite 407, Oakland, California. You can contact this provider via phone number 5104190230 and fax number 5104190273. The mailing address for Gordon Avery Lake is 350 30th Street, Suite 407, Oakland, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Gordon Avery Lake |
|---|---|
| Address | 350 30th Street, Suite 407, Oakland, California |
| Phone Number | 5104190230 |
| Fax Number | 5104190273 |
| Sole Proprietor | Y |
| Credentials | MD |
NPI Number Detail
| NPI Number | 1356379838 |
|---|---|
| Provider Enumeration Date | 2006-06-30 |
| Last Updated Date | 2016-01-19 |
Provider Mailing Address Detail
| Address | 350 30th Street, Suite 407 |
|---|---|
| City | Oakland |
| State | California (CA) |
| Post Code | 94609 |
| Phone Number | 5104190230 |
| Fax Number | 5104190273 |
Provider's Primary Taxonomy Detail
| Speciality | Adult Medicine |
|---|---|
| Taxonomy | 207Qa0505X |
| Licence No | G22921 |
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Definition: The NUCC recommends this code not be used. Choose a more appropriate code. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 00G229210 | CA | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Gordon Avery Lake by the Centers for Medicare & Medicaid Services (CMS)?
The Gordon Avery Lake has been assigned the NPI (National Provider Identifier) 1356379838. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Can you provide the Gordon Avery Lake's physical address?
The Gordon Avery Lake is physically located at 350 30Th Street, Suite 407, in the city of Oakland, CA, with the postal code 94609.
What is the area of specialization for Gordon Avery Lake, and what is the corresponding taxonomy classification code for this field?
The specialized field of practice for Gordon Avery Lake is Adult Medicine, and the corresponding taxonomy code that categorizes this area of expertise is 207Qa0505X.
On what date did Gordon Avery Lake receive its 1356379838 assignment from the Centers for Medicare & Medicaid Services?
The Gordon Avery Lake was assigned its 1356379838 on 2006-06-30, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
When was the information pertaining to Gordon Avery Lake most recently updated or revised?
The details related to Gordon Avery Lake, including its address, specialty, and other relevant information, were last updated or revised on 2016-01-19.
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