Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | M-10574 | ID |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | M-10574 | ID |
NPI | 1770796583 |
---|---|
Provider Name | Dr. Richard Garrett Lee |
First Address | Idaho Falls, ID 83404-8262 |
Second Address | Idaho Falls, ID 83404-8262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 23/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1770796583 | (05) | ID |