Healthcare Provider Details

I. General information

NPI: 1023083466
Provider Name (Legal Business Name): RYAN S LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 COMANCHE RD
FORT MEADE SD
57741-1002
US

IV. Provider business mailing address

1714 WEST BLVD
RAPID CITY SD
57701-4556
US

V. Phone/Fax

Practice location:
  • Phone: 605-720-7224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number237793
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: