Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD 23594 | OR |
NPI | 1194708230 |
---|---|
Provider Name | Thomas Lee |
First Address | Portland, OR 97223-8692 |
Second Address | Portland, OR 97225-6772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 20/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286895 | (05) | OR |
H 63818 | (02) | OR |
R158355 | MEDICARE PTAN (01) | OR |