MEDICARE: DR. WAYLAND SHERROD 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	207Y00000X	Otolaryngology Physician	MD10109	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0189210	OTHER	WA	PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740283407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYLAND SHERROD LEE MD

Provider Business Mailing Address
First Line	:	904 SW BAY ST
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-4860
Country	:	US
Telephone Number	:	541-574-4677
Fax Number	:	541-574-4663

Provider Business Practice Location Address
First Line	:	904 SW BAY ST
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-4860
Country	:	US
Telephone Number	:	541-574-4677
Fax Number	:	541-574-4663

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/15/2013

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