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1710410998
JUSTIN JEFFEREY LAKE
DAYTON, OH
NPI
1710410998
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207P00000X Emergency Medicine
(Licence: OH 34.013545)
Enumeration Date
2017-04-05
Last Update Date
2020-07-27
Business Address
JUSTIN JEFFEREY LAKE
405 W GRAND AVE
DAYTON, OH 45405-7538
Phone number: 937-723-3245
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Mailing Address
JUSTIN JEFFEREY LAKE
3131 NEWMARK DR STE 210
MIAMISBURG, OH 45342-5400
Phone number: 937-438-8910
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