GORDON AVERY LAKE (NPI# 1356379838) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356379838 |
| Entity Type | Individual |
| Full Name | GORDON AVERY LAKE |
| Credential | MD |
| Practice Address |
350 30th Street, Suite 407 Oakland CA 94609 |
| Practice Telephone | 5104190230 |
| Practice Fax Number | 5104190273 |
| Mailing Telephone | 5104190230 |
| Mailing Fax Number | 5104190273 |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2016-01-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
G22921 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G229210 | 05 |
| Street Address |
350 30TH STREET, SUITE 407 |
| City | OAKLAND |
| State | CA |
| Zip Code | 94609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104457159 | Gerard John-charles Coughlin | Student in an Organized Health Care Education/Training Program | Samuel Merritt University, 3100 Telegraph Avenue, Oakland, CA 94609 | 2020-01-29 |
| 1417502022 | Michael Knittel | Registered Nurse | 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1962057562 | Nicole Kjolby | Registered Nurse | Samuel Merritt College, 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1396208286 | Graham Vallis | Student in an Organized Health Care Education/Training Program | Ucsf Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA 94609 | 2019-04-09 |
| 1386129526 | Gary Mitchell Snider | Counselor | 390 40th Street, Oakland, CA 94609 | 2018-10-02 |
| 1720568389 | Lice Control Inc. | Technician | 6557 Shattuck Ave, Oakland, CA 94609 | 2018-08-14 |
| 1528559150 | Jenna Marie Kincaid | Behavior Technician | 400 29th St., 204, Oakland, CA 94609 | 2018-05-18 |
| 1336656669 | Nicholas Dicarlo | Social Worker | 465 34th St Ste 6, Oakland, CA 94609 | 2018-01-09 |
| 1174045744 | Theodora J Marzouk | Home Health Aide | 3317 Elm Street, Suite 202, Oakland, CA 94609 | 2017-07-14 |
| 1740728922 | Elena Gardella | Marriage & Family Therapist | 411 30th Street, Suite 412, Oakland, CA 94609 | 2017-02-07 |
| Find all providers in zip 94609 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104262948 | Sarah Uddin | Family Medicine | 43 Yawpo Ave Ste 3, Oakland, NJ 07436-2717 | 2013-05-20 |
| 1528196326 | Grace G Lat | Family Medicine | 6599 Foothill Blvd., Oakland, CA 94605 | 2007-03-01 |
| 1124100110 | Vanessa Litman | Family Medicine | 3451 E. 12th St., Oakland, CA 94601 | 2006-10-19 |
| 1700857919 | Paul Robert Perchonock | Family Medicine | 461 34th St, Oakland, CA 94609-2815 | 2006-01-27 |
| 1437438454 | Lifelong Medical Care | Family Medicine | 7200 Bancroft Ave, Suite 125a, Oakland, CA 94605-2403 | 2011-08-08 |
| 1871685255 | Bruce Lawrence Md Prof Corp | Family Medicine | 445 30th St, 2nd Floor, Oakland, CA 94609-3301 | 2006-09-29 |
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|---|---|---|---|---|
| 1306446091 | Candace Maglinao | Family Medicine | 21010 Anza Ave Apt 12, Torrance, CA 90503-4254 | 2020-10-30 |
| 1942826797 | In-home Medical Mobile Services, Inc. | Family Medicine | 3400 E 8th St Ste 202, National City, CA 91950-3169 | 2020-06-17 |
| 1386269306 | Universal Mobile Doctors Inc | Family Medicine | 15333 Sherman Way Ste P, Van Nuys, CA 91406-4204 | 2020-06-16 |
| 1619597671 | Harry Eisenbach | Family Medicine | 9312 Smoketree Ln, Villa Park, CA 92861-1011 | 2020-04-20 |
| 1669092854 | Wellbeing Clinic Inc | Family Medicine | 1621 S New Hampshire Ave, Los Angeles, CA 90006-4513 | 2020-04-17 |
| 1619513611 | Krista Mckinney | Family Medicine | 344o E. La Palma Avenue, Anaheim, CA 92806 | 2019-11-25 |
| 1457995565 | Ucsf Medical Group Business Services | Family Medicine | 1100 Park Pl Ste 100, San Mateo, CA 94403-7119 | 2019-10-31 |
| 1780237313 | Charles Kim Md Inc | Family Medicine | 3055 W Orange Ave Ste 204, Anaheim, CA 92804-3154 | 2019-07-23 |
| 1083277206 | Baum 5 Star Healthcare | Family Medicine | 560 W Grangeville Blvd Ste A, Hanford, CA 93230-2858 | 2019-04-15 |
| 1477025278 | Connexus Family Clinic Inc | Family Medicine | 1930 E. Anaheim Street, N/a, Long Beach, CA 90813-3908 | 2018-12-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.