Jeremy M Lake, MD LLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MD24736 Issued in OR

Legal business name

JEREMY M LAKE, MD LLC

Practice address

232 SE 7TH Ave
Hillsboro, OR 97123-4133

Phone

(503) 640-1614

Fax

(503) 681-0925

NPI assigned

Dec 28, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeremy M Lake, MD

Title

MD

Phone

(503) 640-1614

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198800000000",
    "number": "1881878650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 SE 7TH AVE",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971234133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 SE 7TH AVE",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971234133",
            "telephone_number": "503-640-1614",
            "fax_number": "503-681-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEREMY M LAKE, MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-28",
        "last_updated": "2007-12-28",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "503-640-1614",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OR",
            "license": "MD24736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Hillsboro, OR
• Providers in Hillsboro, OR by specialty
• Gastroenterology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.