Provider Demographics
NPI:1033298724
Name:LEE, PAUL H (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:H
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 1:5351 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1914
Mailing Address - Country:US
Mailing Address - Phone:650-804-2990
Mailing Address - Fax:
Practice Address - Street 1:1805 N CALIFORNIA ST STE 201
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6032
Practice Address - Country:US
Practice Address - Phone:209-645-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68537208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G685370Medicaid
CA00G685370Medicaid
00G685370Medicare ID - Type Unspecified