Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101238427 | VA |
N | 2080P0202X | Pediatric Cardiologist | 0101238427 | VA |
Y | 2080P0202X | Pediatric Cardiologist | E-12039 | AR |
NPI | 1275637654 |
---|---|
Provider Name | Dr. Sam M Lee |
First Address | Little Rock, AR 72202-3500 |
Second Address | Little Rock, AR 72202-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
234430001 | (05) | AR |
I39634 | (02) |