Healthcare Provider Details

I. General information

NPI: 1962660969
Provider Name (Legal Business Name): SUZANNE LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 S 500 W STE 1
BRIGHAM CITY UT
84302-3094
US

IV. Provider business mailing address

2621 S 3270 W STE 110
WEST VALLEY CITY UT
84119-1119
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-8276
  • Fax: 877-497-4661
Mailing address:
  • Phone: 385-261-2614
  • Fax: 877-497-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-10750
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8088255-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: