Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 01086218A | IN |
NPI | 1386905099 |
---|---|
Provider Name | Nathaniel A Lee |
First Address | Santa Monica, CA 90404-2312 |
Second Address | Indianapolis, IN 46227-7506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 04/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300052400 | (05) | IN |