Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 36758 | NC |
NPI | 1023060068 |
---|---|
Provider Name | Dr. Barry Russell Lee |
First Address | Huntersville, NC 28078-9120 |
Second Address | Gastonia, NC 28054-3438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 27/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8951408 | (05) | NC |
E57307 | (02) |