Healthcare Provider Details

I. General information

NPI: 1548310352
Provider Name (Legal Business Name): DAVID H. LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 A AVE STE 200
LAKE OSWEGO OR
97034-3078
US

IV. Provider business mailing address

PO BOX 6689
PORTLAND OR
97228-6689
US

V. Phone/Fax

Practice location:
  • Phone: 503-635-2496
  • Fax: 503-635-2497
Mailing address:
  • Phone: 503-635-2496
  • Fax: 503-635-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD25906
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA84664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: