Provider Demographics
NPI:1073619607
Name:LEE, PERRY P (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:P
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 1:3000 COLBY ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2083
Mailing Address - Country:US
Mailing Address - Phone:510-666-0854
Mailing Address - Fax:510-666-1192
Practice Address - Street 1:350 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3108
Practice Address - Country:US
Practice Address - Phone:510-655-4000
Practice Address - Fax:510-869-8906
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71117207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A711170Medicaid
CA00A711170Medicaid
CA00A711170Medicare ID - Type Unspecified