| Jack F Lake, PA-C | |
|
2748 Milton Way, Ste 101, Milton, WA 98354-9382 | |
| (253) 922-5262 | |
| (253) 922-5299 |
| Full Name | Jack F Lake |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 2748 Milton Way, Milton, Washington |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| 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 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | PA10001841 (Washington) | Primary |
| 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 |
Mrs. Audrey Rose Guillermo Lewkowitz, PHYSICIAN ASSISTANT Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2748 Milton Way Ste 101, Milton, WA 98354 Phone: 253-922-5262 Fax: 253-922-5299 |