MEDICARE: DAVID M. LAKES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	G22953	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558445536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M. LAKES MD

Provider Business Mailing Address
First Line	:	249 REDWOOD RD
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-2751
Country	:	US
Telephone Number	:	415-454-8611
Fax Number	:

Provider Business Practice Location Address
First Line	:	249 REDWOOD RD
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-2751
Country	:	US
Telephone Number	:	415-444-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	12/11/2007

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