Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 56974 | MN |
N | 2081S0010X | Sports Medicine | 56974 | MN |
N | 213ES0000X | Sports Medicine | 56974 | MN |
NPI | 1003077223 |
---|---|
Provider Name | Dr. Jason Allen Lee |
First Address | Faribault, MN 55021-6319 |
Second Address | Faribault, MN 55021-6319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 10/01/2022 |