MEDICARE: EDWARD D LEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	G84388	CA

General Provider Information

NPI Number	:	1427039288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD D LEE MD

Provider Business Mailing Address
First Line	:	2100 POWELL ST
Second Line	:	STE 900
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-1844
Country	:	US
Telephone Number	:	510-350-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2070 CLINTON AVE
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4399
Country	:	US
Telephone Number	:	510-523-4357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	01/04/2018

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