Provider Demographics
NPI:1164574273
Name:LEE, ELIZABETH SLASS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SLASS
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2999 REGENT STREET #401
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705
Mailing Address - Country:US
Mailing Address - Phone:501-704-2170
Mailing Address - Fax:510-704-2173
Practice Address - Street 1:2999 REGENT STREET #401
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:501-704-2170
Practice Address - Fax:510-704-2173
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG081425208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G814250Medicare PIN
F86014Medicare UPIN