Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 01039322A | IN |
NPI | 1083641849 |
---|---|
Provider Name | David C Lee |
First Address | Auburn, IN 46706-0623 |
Second Address | Auburn, IN 46706-2535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 29/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036048308 | (05) | IL |
216-07247 | BCBS (01) | IL |
C40257 | (02) | IL |