Provider Demographics
NPI:1538329222
Name:LAKE, YASMIN NATASHA (MD)
Entity type:Individual
Prefix:DR
First Name:YASMIN
Middle Name:NATASHA
Last Name:LAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:1500 CITYWEST BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:713-458-4229
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP20030297207L00000X
TXN8534207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287533802Medicaid
TX281533801Medicaid
TXP01746231OtherRR MEDICARE
TX8W9814OtherBLUE CROSS BLUE SHIELD
TXTXB143120Medicare PIN