Provider Demographics
NPI:1609195189
Name:LAKE, JASON GREER (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GREER
Last Name:LAKE
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:3S34
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6006
Mailing Address - Fax:314-454-4102
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:3S34
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6006
Practice Address - Fax:314-454-4102
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2021-11-17
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Provider Licenses
StateLicense IDTaxonomies
MO2012015095208000000X
UT11680333-12052080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics