Marcy G Lake, D.O.

NPI #1174550123 in Beaverton, Oregon

Provider Information

NPI Number: 1174550123
Entity Type: Individual
Name: Marcy G Lake, D.O.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Family Medicine
Credential: D.O.
Enumeration Date: Jun 27, 2006
Last Updated: Dec 30, 2015

Practice Location

Address: 4855 SW WESTERN AVE
City: Beaverton
State: Oregon
ZIP Code: 97005-3460
Phone: (503) 813-2000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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