Provider Demographics
NPI:1083029995
Name:LEE, EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5015
Mailing Address - Country:US
Mailing Address - Phone:253-245-9299
Mailing Address - Fax:253-604-1259
Practice Address - Street 1:206 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5015
Practice Address - Country:US
Practice Address - Phone:253-245-9299
Practice Address - Fax:253-604-1259
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery