Provider Demographics
NPI:1245421551
Name:LEE, BOB YUAN WEN (MD)
Entity Type:Individual
Prefix:
First Name:BOB
Middle Name:YUAN WEN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-7360
Mailing Address - Fax:541-732-8361
Practice Address - Street 1:827 SPRING ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6111
Practice Address - Country:US
Practice Address - Phone:541-732-8360
Practice Address - Fax:541-732-8361
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD157659208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500645855Medicaid
R164154Medicare PIN