Active NPI
Anna Lake, MD
- Family Medicine Physician
- Albuquerque, NM
National Provider Identifier
1700860756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 91236
- Practice address
- 1 University of New Mexico
Msc06 3870
Albuquerque, NM 87131-0001 - Phone
- (505) 277-3136
- Fax
- (505) 277-2020
- NPI assigned
- Dec 2, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 91236 | NM | Primary |
Addresses
Primary practice location
1 University of New Mexico
Msc06 3870
Albuquerque, NM 87131-0001
Mailing address
1 University of New Mexico
Msc06 3870
Albuquerque, NM 87131-0001
Phone (505) 277-3136
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20007 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 91236 | NM | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478563200000",
"number": "1700860756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 UNIVERSITY OF NEW MEXICO",
"address_2": "MSC06 3870",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871310001",
"telephone_number": "505-277-3136",
"fax_number": "505-277-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 UNIVERSITY OF NEW MEXICO",
"address_2": "MSC06 3870",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871310001",
"telephone_number": "505-277-3136",
"fax_number": "505-277-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "ANNA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-02",
"last_updated": "2016-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NM",
"license": "91236",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20007",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.