MEDICARE: RICHARD M 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	207VM0101X	Maternal & Fetal Medicine Physician	M-9586	ID
2	207VM0101X	Maternal & Fetal Medicine Physician	TL3725	ID

General Provider Information

NPI Number	:	1588692933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD M LEE MD

Provider Business Mailing Address
First Line	:	PO BOX 190930
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83719-0930
Country	:	US
Telephone Number	:	208-367-5170
Fax Number	:	208-367-5180

Provider Business Practice Location Address
First Line	:	900 N LIBERTY ST STE 206
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-8729
Country	:	US
Telephone Number	:	208-302-1100
Fax Number	:	208-302-1155

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	11/22/2024

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