Provider Demographics
NPI:1366441206
Name:LEE, DAVE H (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVE
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4110 BRIARGATE PKWY
Mailing Address - Street 2:SUITE 440
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7835
Mailing Address - Country:US
Mailing Address - Phone:719-574-1654
Mailing Address - Fax:719-574-5381
Practice Address - Street 1:4110 BRIARGATE PKWY
Practice Address - Street 2:SUITE 440
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7835
Practice Address - Country:US
Practice Address - Phone:719-574-1654
Practice Address - Fax:719-574-5381
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO42628207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96201762Medicaid
C531598Medicare PIN
COH92784Medicare UPIN
CO531598Medicare ID - Type Unspecified
CO96201762Medicaid