Provider Demographics
NPI:1093738213
Name:LEE, CAROL E (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:E
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6856 SW BANCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1907
Mailing Address - Country:US
Mailing Address - Phone:503-297-7672
Mailing Address - Fax:
Practice Address - Street 1:6856 SW BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1907
Practice Address - Country:US
Practice Address - Phone:503-297-7672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13322207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR050050025OtherRR MEDICARE
OR280818Medicaid
WA1051903Medicaid
ID805245000Medicaid
CAXPY149780Medicaid
AKMD6352RMedicaid
ID805245000Medicaid
OR280818Medicaid