Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD60127504 | WA |
N | 111NI0900X | Internist | MD60127504 | WA |
N | 207RC0200X | Critical Care Medicine | 5834656-1205 | UT |
Y | 207RC0200X | Critical Care Medicine | MD60127504 | WA |
NPI | 1013937663 |
---|---|
Provider Name | Martin Mao-Ting Lee |
First Address | Puyallup, WA 98372-4661 |
Second Address | Puyallup, WA 98372-4661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 19/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107038443101 | IHC (01) | UT |
239024 | ALTIUS (01) | UT |
76-00071 | UNITED HEALTHCARE (01) | UT |
83555 | PEHP (01) | UT |
870281028000 | (05) | UT |
870281028LEE | EMIA (01) | UT |
902460 | DMBA (01) | UT |
I37650 | (02) | UT |
P00299426 | PALMETTO (01) | UT |