Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 2000148981 | MO |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 81540 | GA |
NPI | 1134238728 |
---|---|
Provider Name | Richard Lee |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912-2539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 11/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
177919 | BLUE CROSS BLUE SHIELD (01) | |
208836809 | (05) | MO |
42733 | HEALTHCARE USA (01) | |
551829 | HEALTHLINK (01) | |
7395391 | AETNA (01) | |
84115 | HEALTH ALLIANCE (01) | |
H66549 | (02) | |
O00078116 | MEDICARE RAILROAD (01) | MO |