Provider Demographics
NPI:1164511754
Name:LEE, VERNON YJ (DO PC)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:YJ
Last Name:LEE
Suffix:
Gender:M
Credentials:DO PC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9141 GRANT ST
Mailing Address - Street 2:SUITE 245
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229
Mailing Address - Country:US
Mailing Address - Phone:303-252-0550
Mailing Address - Fax:303-252-9493
Practice Address - Street 1:9141 GRANT ST
Practice Address - Street 2:SUITE 245
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229
Practice Address - Country:US
Practice Address - Phone:303-252-0550
Practice Address - Fax:303-252-9493
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COCOLO18181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01181072Medicaid
CO01181072Medicaid