Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30.021802 | OH |
NPI | 1013997519 |
---|---|
Provider Name | Dr. Jeffery S Lee |
First Address | Cambridge, OH 43725-9034 |
Second Address | Cambridge, OH 43725-9034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 03/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V11508 | (02) | OH |