Provider Demographics
NPI:1003808627
Name:LEE, MAX M (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19711 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2401
Mailing Address - Country:US
Mailing Address - Phone:206-824-2183
Mailing Address - Fax:
Practice Address - Street 1:19711 1ST AVE S
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2401
Practice Address - Country:US
Practice Address - Phone:206-824-2183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1592708Medicaid
WA760111256OtherRR MEDICARE
WA1592708Medicaid
A04989Medicare UPIN