GARY BRADLEY LAKE MD
NPI 1679518708
Internal Medicine in Tuba City, AZ

Q: What is Gary Lake's NPI number?

The NPI number for Gary Lake is 1679518708. It was assigned to this individual provider in the NPPES registry on June 20, 2006.

Q: What is Gary Lake's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Q: When was this NPI record last updated?

The NPPES record for Gary Lake was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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 20, 2006

167 NORTH MAIN STREET, TUBA CITY, AZ 86045(928) 283-2501(928) 283-2677 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Gary Bradley Lake Md NPPES

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

GARY BRADLEY LAKE MD (NPI 1679518708) is an individual internal medicine provider in Tuba City, Arizona, licensed in Arizona (29509) and active in the NPI registry since June 2006.

NPPES Registry Identity

NPI1679518708

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameGARY BRADLEY LAKECredential: MD

Location Address167 NORTH MAIN STREETTuba City, AZ 86045-0600

Mailing AddressPo Box 600, 167 North Main StreetTuba City, AZ 86045-0600 · (928) 283-2501 · Fax (928) 283-2677

Phone(928) 283-2501

Fax(928) 283-2677

Sole ProprietorNo

Enumeration DateJune 20, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1679518708 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in AZ · 29509

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

167 NORTH MAIN STREET, Tuba City, AZ 86045

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Other Identifiers 3

Medicare ID-Type Unspecified8EZ35N

Medicare UPINCO3287

Medicaid821702AZ

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JIMMIE L TAYLOR RN

Registered Nurse (Ambulatory Care)