JONATHAN L LAKE

CHARLOTTE, NC
NPI1346283801
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AS0400X Physician Assistant, Surgical
(Licence: NC  103630)
Additional Taxonomies363A00000X Physician Assistant
(Licence: NC  103630)
Enumeration Date2006-06-13
Last Update Date2020-12-22
Business Address
JONATHAN L LAKE PAC
225 BALDWIN AVE
CHARLOTTE, NC 28204-3109
Phone number: 704-376-1605
Mailing Address
JONATHAN L LAKE PAC
225 BALDWIN AVE
CHARLOTTE, NC 28204-3109
Phone number: 704-376-1605