MEDICARE: JOYCE L LEE M.D.

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	208D00000X	General Practice Physician	24739	OR

General Provider Information

NPI Number	:	1982671350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE L LEE M.D.

Provider Business Mailing Address
First Line	:	10964 SW BLACK DIAMOND WAY
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-4289
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7175 SW BEVELAND RD
Second Line	:	STE 205
City	:	TIGARD
State	:	OR
Zip	:	97223-8665
Country	:	US
Telephone Number	:	503-312-0367
Fax Number	:

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	07/08/2007

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