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General NPI Number Information
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NPI Number | 1801078159
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Entity Type | Individual
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Provider Name | MARK YOUNG LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | WILLIAM BEAUMONT ARMY MEDICAL CENTER, PLASTIC SURGERY C 18511 HIGHLANDER MEDICS ST.
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City | FORT BLISS
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State | TX
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Zip | 79918
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Country | US
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Telephone | 808-388-2790
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Fax | 915-569-0725
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Provider Business Mailing Address
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Address Line | WILLIAM BEAUMONT ARMY MEDICAL CENTER, PLASTIC SURGERY C 18511 HIGHLANDER MEDICS ST.
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City | FORT BLISS
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State | TX
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Zip | 79918
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Country | US
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Telephone | 808-388-2790
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Fax | 915-569-0725
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C170505
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 026278
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 026278
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | C170505
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License Number State | CA
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