MEDICARE: ANTHONY H. LEE, M.D. PC

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	207Q00000X	Family Medicine Physician	15438MD	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1497846489	OTHER	OR	APPLYING THE ANTHONY H. L

General Provider Information

NPI Number	:	1508066267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY H. LEE, M.D. PC

Provider Business Mailing Address
First Line	:	4670 SW WASHINGTON AVE
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-0530
Country	:	US
Telephone Number	:	503-646-5516
Fax Number	:	503-520-9436

Provider Business Practice Location Address
First Line	:	4670 SW WASHINGTON AVE
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-0530
Country	:	US
Telephone Number	:	503-646-5516
Fax Number	:	503-520-9436

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY H LEE
Credential	:	M.D.
Telephone Number	:	503-646-5516

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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