Provider Demographics
NPI:1053317818
Name:LEE, RAYMOND W (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:W
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 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:STE 245
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1588
Mailing Address - Country:US
Mailing Address - Phone:408-923-3388
Mailing Address - Fax:
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:STE 245
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1588
Practice Address - Country:US
Practice Address - Phone:408-923-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2008-05-13
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
CAG44983207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G449830Medicare PIN