Provider Demographics
NPI:1376637058
Name:DR. PETER LEE D.O.
Entity Type:Organization
Organization Name:DR. PETER LEE D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-624-7070
Mailing Address - Street 1:PO BOX 620
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905
Mailing Address - Country:US
Mailing Address - Phone:620-624-7070
Mailing Address - Fax:620-624-7757
Practice Address - Street 1:23 EAST 11TH
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901
Practice Address - Country:US
Practice Address - Phone:620-624-7070
Practice Address - Fax:620-624-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0522558261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110913OtherBCBS GROUP #
KS110913OtherBCBS GROUP #
KSX89482Medicare UPIN