Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Gordon Avery Lake, MD

Individual provider Adult Medicine Physician · NPI 1356379838

Gordon Avery Lake, MD is an Adult Medicine Physician in Oakland, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

350 30th St Ste 407
Oakland, CA 94609 Not confirmed with CMS for 10 years — call before visiting
Phone: (510) 419-0230
Fax: (510) 419-0273
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Medicine Physician (primary) Taxonomy 207QA0505X · Licence G22921 (CA)

Record details

NPI number1356379838
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJune 30, 2006
Last updated in NPPESJanuary 19, 2016

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