Provider Demographics
NPI:1376784314
Name:LEE, PETER MJ (MD, MHS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MJ
Last Name:LEE
Suffix:
Gender:M
Credentials:MD, MHS
Other - Prefix:DR
Other - First Name:MYUNG
Other - Middle Name:J
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MHS
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-1620
Mailing Address - Fax:503-494-6670
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-1620
Practice Address - Fax:503-494-6670
Is Sole Proprietor?:No
Enumeration Date:2009-03-22
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD211874207R00000X, 207RC0200X, 207RP1001X
VA0101259077207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine