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General NPI Number Information
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NPI Number | 1508867656
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Entity Type | Individual
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Provider Name | BRIAN J LEE MD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 7910 W JEFFERSON BLVD STE 212
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City | FORT WAYNE
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State | IN
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Zip | 46804-4159
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Country | US
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Telephone | 260-427-7473
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Fax | 260-432-3189
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Provider Business Mailing Address
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Address Line | 7910 W JEFFERSON BLVD STE 212
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City | FORT WAYNE
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State | IN
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Zip | 46804-4159
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Country | US
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Telephone | 260-427-7473
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Fax | 260-432-3189
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 01040298A
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License Number State | IN
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