Provider Demographics
NPI:1407099534
Name:LEE, THOMAS S (NMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 STOCKTON HILL RD # A304
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5139
Mailing Address - Country:US
Mailing Address - Phone:928-767-4743
Mailing Address - Fax:951-571-1339
Practice Address - Street 1:1308 STOCKTON HILL RD # A304
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5139
Practice Address - Country:US
Practice Address - Phone:928-767-4743
Practice Address - Fax:951-571-1339
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ89-0396175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ89-0396OtherMEDICAL LICENSE