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General NPI Number Information
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NPI Number | 1356500086
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Entity Type | Organization
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Legal Business Name | ROBERT J. LEE, M.D., PC
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 09/11/2010
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Provider Practice Location Address
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Address Line | 3446 S 15TH E
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8262
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Country | US
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Telephone | 208-522-4409
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Fax | 208-522-4497
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Provider Business Mailing Address
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Address Line | PO BOX 1583
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City | IDAHO FALLS
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State | ID
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Zip | 83403-1583
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Country | US
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Telephone | 208-522-4409
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Fax | 208-522-4497
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT JENSEN LEE
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Credential | M.D.
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Telephone | 208-522-4409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | M7277
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License Number State | ID
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