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General NPI Number Information
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NPI Number | 1952817439
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Entity Type | Organization
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Legal Business Name | DR. MAGE R. LEE
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 1203 MOUNT AVE
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City | MISSOULA
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State | MT
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Zip | 59801-5601
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Country | US
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Telephone | 406-543-5251
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 MOUNT AVE
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City | MISSOULA
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State | MT
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Zip | 59801-5601
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Country | US
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Telephone | 406-543-5251
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAGE R LEE
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Credential | DC
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Telephone | 406-543-5251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | MT
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