Healthcare Provider Details

I. General information

NPI: 1417390014
Provider Name (Legal Business Name): GRACE LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 POYDRAS ST STE 1641
NEW ORLEANS LA
70112-1227
US

IV. Provider business mailing address

PO BOX 140114
ANCHORAGE AK
99514-0114
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-8313
  • Fax:
Mailing address:
  • Phone: 907-538-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number313207
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: