Provider Demographics
NPI:1285969402
Name:LAKE, DAVID ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:LAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3173 SOUTH CT
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2948
Mailing Address - Country:US
Mailing Address - Phone:650-380-3243
Mailing Address - Fax:650-321-1916
Practice Address - Street 1:550 HAMILTON AVE STE 202
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2030
Practice Address - Country:US
Practice Address - Phone:650-321-1916
Practice Address - Fax:650-321-1916
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG297852084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry