Provider Demographics
NPI:1871794404
Name:LAKE, JAMES HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HENRY
Last Name:LAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 CASS ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4536
Mailing Address - Country:US
Mailing Address - Phone:831-644-9125
Mailing Address - Fax:
Practice Address - Street 1:1015 CASS ST
Practice Address - Street 2:SUITE 8
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4536
Practice Address - Country:US
Practice Address - Phone:831-644-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG772372084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine