Provider Demographics
NPI:1235247107
Name:LEE, EUGENE WAY (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:WAY
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 J STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3840
Mailing Address - Country:US
Mailing Address - Phone:916-454-9111
Mailing Address - Fax:916-454-2977
Practice Address - Street 1:5120 J STREET
Practice Address - Street 2:SUITE B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3840
Practice Address - Country:US
Practice Address - Phone:916-454-9111
Practice Address - Fax:916-454-2977
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0419462086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8730518Medicaid
CA00G419460Medicare ID - Type Unspecified
CA8730518Medicaid