Provider Demographics
NPI:1235641747
Name:LEE, BROOKE M (PA-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6577
Mailing Address - Country:US
Mailing Address - Phone:480-895-5870
Mailing Address - Fax:480-895-0573
Practice Address - Street 1:245 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-895-5870
Practice Address - Fax:480-895-0573
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6922363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6922OtherARIZONA REGULATORY BOARD OF PHYSICIANS ASSISTANTS