| Organization Name: | LAKES MEDICAL CLINIC |
| NPI Number: | 1225237563 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES D LAYMAN (M.D.) |
| Mailing Address: | 5050 Dunbar Street Suite D Wasilla |
| State: | AK US |
| Postal Code: | 99654 |
| Phone Number: | 9073570820 |
| Fax Number: | 9073570821 |
| NPI Enumeration Date: | 07/17/2007 |
| NPI Last Update Date: | 07/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |