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General NPI Number Information
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NPI Number | 1205399391
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Entity Type | Individual
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Provider Name | BRUCE LEE MD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2019
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 1400 BELLINGER ST
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City | EAU CLAIRE
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State | WI
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Zip | 54703-9943
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Country | US
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Telephone | 715-838-5222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 860912
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-0912
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Country | US
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Telephone | 507-284-2511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME162449
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 85412
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License Number State | WI
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