Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD15362 | OR |
NPI | 1164514204 |
---|---|
Provider Name | Michael James Lee |
First Address | Portland, OR 97225-6663 |
Second Address | Portland, OR 97225-6663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 14/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151910 | (05) | OR |
C93128 | (02) |