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

Justin Jefferey Lake

Individual provider Emergency Medicine Physician · NPI 1710410998

Justin Jefferey Lake is an Emergency Medicine in Dayton, Ohio. Graduated from Ohio University, College of Osteopathic Medicine in 2017, 9 years ago. Practices with Phs Emergency Billing LLC, a 71-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Ohio.

Years since qualifying
9
Trained at
Ohio University, College of Osteopathic Medicine
Licensed in
OH
In the registry since
2017
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Practice location Address checks out

405 W Grand Ave
Dayton, OH 45405-7538
Phone: (937) 723-3245
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 3535 Southern Blvd, Kettering, OH 45429-1221 — (937) 395-8166
  • 4000 Miamisburg Centerville Rd, Miamisburg, OH 45342-7615 — (937) 384-8791

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 34.013545 (OH)

Record details

NPI number1710410998
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 5, 2017
Last updated in NPPESJuly 27, 2020
Certification dateJuly 27, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolOHIO UNIVERSITY, COLLEGE OF OSTEOPATHIC MEDICINE
Graduated 2017 (9 years in practice)
Group practice Phs Emergency Billing Llc — 71 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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