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General NPI Number Information
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NPI Number | 1831353291
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Entity Type | Organization
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Legal Business Name | DR. JOHN LEE MD PC
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 484 MESSENGER RD
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City | KEOKUK
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State | IA
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Zip | 52632-2115
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Country | US
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Telephone | 319-524-6311
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Fax | 319-524-0868
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Provider Business Mailing Address
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Address Line | 484 MESSENGER RD
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City | KEOKUK
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State | IA
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Zip | 52632-2115
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Country | US
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Telephone | 319-524-6311
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Fax | 319-524-0868
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN W LEE
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Credential | MD
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Telephone | 319-524-6311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20680
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License Number State | IA
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