Provider Demographics
NPI:1043200959
Name:LEE, GREGORY J (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1070 COPPERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-9076
Mailing Address - Country:US
Mailing Address - Phone:812-951-2400
Mailing Address - Fax:812-951-0203
Practice Address - Street 1:1070 COPPERFIELD DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9076
Practice Address - Country:US
Practice Address - Phone:812-951-2400
Practice Address - Fax:812-951-0203
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01045612A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING44063Medicare UPIN