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General NPI Number Information
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NPI Number | 1306857123
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Entity Type | Individual
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Provider Name | MATTHEW JEREMY LEE A.R.N.P
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 101 S MOORE AVE
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City | CLAREMORE
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State | OK
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Zip | 74017-5047
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Country | US
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Telephone | 918-342-6200
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Fax | 918-342-6598
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Provider Business Mailing Address
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Address Line | 4504 S MAPLE AVE
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City | BROKEN ARROW
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State | OK
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Zip | 74011-3027
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Country | US
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Telephone | 918-557-4443
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R0075713
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License Number State | OK
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