MEDICARE: MS. BRIDGET MARIE LEE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA059528	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA059528	OTHER	PA	PA LICENSE

General Provider Information

NPI Number	:	1346758398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRIDGET MARIE LEE PA-C

Provider Business Mailing Address
First Line	:	777 BANNOCK STREET
Second Line	:	DAVIS PAVILLION
City	:	DENVER
State	:	CO
Zip	:	80204
Country	:	US
Telephone Number	:	303-436-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 BANNOCK STREET
Second Line	:	DAVIS PAVILLION
City	:	DENVER
State	:	CO
Zip	:	80204-8020
Country	:	US
Telephone Number	:	303-436-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2018
Last Update Date	:	03/03/2021

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