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General NPI Number Information
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NPI Number | 1023076874
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Entity Type | Individual
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Provider Name | LADD DANIEL LAKE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 601 W LEOTA ST
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City | NORTH PLATTE
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State | NE
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Zip | 69101-6525
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Country | US
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Telephone | 308-696-7491
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Fax | 308-696-7432
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Provider Business Mailing Address
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Address Line | PO BOX 362
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City | NORTH PLATTE
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State | NE
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Zip | 69103-0362
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Country | US
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Telephone | 866-477-7013
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Fax | 866-902-2445
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 22147
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License Number State | NE
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