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NPI Code Detail

MEDICARE: CHARLES LEE M.D

MEDICARE: CHARLES LEE M.D
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
1207L00000XAnesthesiology Physician2913AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1020257499OTHERAKGROUPS ENERGY EMP#
2193975000OTHERAKGROUPS FED DEPT LABOR#
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4050067817OTHERAKLEE RAILROAD MCR#
5CI9459OTHERAKGROUPS RAILROAD MCR#
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558313866
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES LEE M.D
Provider Business Mailing Address
First Line : PO BOX 853
Second Line :
City : PALMER
State : AK
Zip : 99645-0853
Country : US
Telephone Number : 907-745-0374
Fax Number : 907-745-0200
Provider Business Practice Location Address
First Line : 2500 S WOODWORTH LOOP
Second Line :
City : PALMER
State : AK
Zip : 99645-8984
Country : US
Telephone Number : 907-745-0374
Fax Number : 907-745-0200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 02/04/2013

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