GORDON AVERY LAKE MD
NPI 1356379838
Family Medicine - Adult Medicine in Oakland, CA

Q: What is Gordon Lake's NPI number?

The NPI number for Gordon Lake is 1356379838. It was assigned to this individual provider in the NPPES registry on June 30, 2006.

Q: What is Gordon Lake's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Q: When was this NPI record last updated?

The NPPES record for Gordon Lake was last updated on January 19, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 30, 2006

350 30TH STREET, SUITE 407, OAKLAND, CA 94609(510) 419-0230(510) 419-0273 Get Directions Write a Review

NPPES record last updated: January 19, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Gordon Avery Lake Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GORDON AVERY LAKE MD (NPI 1356379838) is an individual adult medicine provider in Oakland, California, licensed in California (G22921) and active in the NPI registry since June 2006.

NPPES Registry Identity

NPI1356379838

Entity TypeIndividualMale

Primary Taxonomy207QA0505X

Provider Legal NameGORDON AVERY LAKECredential: MD

Location Address350 30TH STREET, SUITE 407Oakland, CA 94609

Mailing Address350 30th Street, Suite 407Oakland, CA 94609 · (510) 419-0230 · Fax (510) 419-0273

Phone(510) 419-0230

Fax(510) 419-0273

Sole ProprietorYes

Enumeration DateJune 30, 2006

Last NPPES UpdateJanuary 19, 2016

✔ NPI 1356379838 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207QA0505X

License✔ Licensed in CA · G22921

Definition

The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

350 30TH STREET, SUITE 407, Oakland, CA 94609

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Other Identifiers 3

Medicare ID-Type Unspecified00G229210CA

Medicare UPINA41775CA

Medicaid00G229210CA

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gordon Lake's NPI number?

The NPI number for Gordon Lake is 1356379838. It was assigned to this individual provider in the NPPES registry on June 30, 2006.

Where is Gordon Lake located?

Gordon Lake practices at 350 30th Street, Suite 407, Oakland, CA 94609. The listed phone number is (510) 419-0230.

What is Gordon Lake's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

When was this NPI record last updated?

The NPPES record for Gordon Lake was last updated on January 19, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.