Healthcare Provider Details

I. General information

NPI: 1861510760
Provider Name (Legal Business Name): IRWIN H LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROFESSIONAL CENTER DR
ROHNERT PARK CA
94928-2152
US

IV. Provider business mailing address

PO BOX 756
DANVILLE CA
94526-0756
US

V. Phone/Fax

Practice location:
  • Phone: 707-584-2200
  • Fax: 707-584-7582
Mailing address:
  • Phone: 209-543-0684
  • Fax: 209-343-3809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301081665
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301081665
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA103038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: