Healthcare Provider Details

I. General information

NPI: 1497744684
Provider Name (Legal Business Name): LEE BURNSIDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 RAINIER AVE S
RENTON WA
98057-2047
US

IV. Provider business mailing address

64 RAINIER AVE S
RENTON WA
98057-2047
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 425-224-2144
  • Fax: 425-341-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00033954
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD33954
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD33954
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: