Provider Demographics
NPI:1932542883
Name:LAKE, EVE MORGAN
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:MORGAN
Last Name:LAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 3RD AVE S
Mailing Address - Street 2:BOX 359945
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2697
Mailing Address - Country:US
Mailing Address - Phone:206-744-1500
Mailing Address - Fax:
Practice Address - Street 1:206 3RD AVE S
Practice Address - Street 2:BOX 359945
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2697
Practice Address - Country:US
Practice Address - Phone:206-744-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML 60371640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine