Provider Demographics
NPI:1346302544
Name:LEE, RAYMOND WM (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:WM
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:82 PUUHONU PLACE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-935-7765
Mailing Address - Fax:808-969-7990
Practice Address - Street 1:82 PUUHONU PLACE
Practice Address - Street 2:SUITE 208
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-935-7765
Practice Address - Fax:808-969-7990
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD94592086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI207571OtherHMSA
HI07881401Medicaid
G30844Medicare UPIN
HI07881401Medicaid