Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 23086 | IA |
NPI | 1083609317 |
---|---|
Provider Name | Phillip C Lee |
First Address | Mason City, IA 50401-2926 |
Second Address | Mason City, IA 50401-2926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 03/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0238253 | (05) | IA |
A03012 | (02) | IA |