Healthcare Provider Details

I. General information

NPI: 1013937663
Provider Name (Legal Business Name): MARTIN MAO-TING LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARTIN LEE

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 23RD AVE SE
PUYALLUP WA
98372-4661
US

IV. Provider business mailing address

702 23RD AVE SE
PUYALLUP WA
98372-4661
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-4378
  • Fax:
Mailing address:
  • Phone: 253-841-4378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60127504
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number5834656-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD60127504
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: