Jack F Lake, PA-C is a
Physician Assistant based in Milton, Washington. Jack F Lake is licensed to practice in Washington (license number PA10001841) and his current practice location is
2748 Milton Way, Ste 101, Milton, Washington. He can be reached at his office (for appointments etc.) via phone at
(253) 922-5262.
NPI number for Jack F Lake is 1427069889 and his current mailing address is 2748 Milton Way, Ste 101, Milton, Washington. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1427069889.
Provider's Profile
| Full Name | Jack F Lake |
|---|
| Gender | Male |
|---|
| Speciality | Physician Assistant |
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| Location | 2748 Milton Way, Milton, Washington |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1427069889
- Provider Enumeration Date: 08/11/2006
- Last Update Date: 11/16/2010
Medical Identifiers
Medical identifiers for Jack F Lake such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1427069889 | NPI | - | NPPES |
| P00153517 | Other | WA | RAILROAD |
| 0186925 | Other | WA | STATE L&I |
| 8940030 | Other | WA | STATE CRIME VICTIMS |
| 8401788 | Medicaid | WA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | PA10001841 (Washington) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jack F Lake is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jack F Lake, PA-C
2748 Milton Way, Ste 101,
Milton, WA 98354-9382
Ph: (253) 922-5262 | Jack F Lake, PA-C
2748 Milton Way, Ste 101,
Milton, WA 98354-9382
Ph: (253) 922-5262 |
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