Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 57982 | AZ |
NPI | 1093071870 |
---|---|
Provider Name | Dr. Bryan S Lee |
First Address | Phoenix, AZ 85013-4434 |
Second Address | Phoenix, AZ 85027-4024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2012 |
Last Update Date | 10/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
504576 | (05) | AZ |