Provider Demographics
NPI:1093952616
Name:LEE, HUBERT W (DPM)
Entity Type:Individual
Prefix:
First Name:HUBERT
Middle Name:W
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 1:12737 BEL-RED RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-455-0936
Mailing Address - Fax:425-462-8080
Practice Address - Street 1:12737 BEL-RED RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2608
Practice Address - Country:US
Practice Address - Phone:425-455-0936
Practice Address - Fax:425-462-8080
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60159067213ES0103X, 213E00000X
PASC006000213ES0103X
FLPO3542213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8893419Medicare PIN