Provider Demographics
NPI:1407831381
Name:LEE, TENNYSON G (MD)
Entity Type:Individual
Prefix:DR
First Name:TENNYSON
Middle Name:G
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 BELL RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9244
Mailing Address - Country:US
Mailing Address - Phone:530-885-0192
Mailing Address - Fax:530-886-5959
Practice Address - Street 1:3200 BELL RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-9244
Practice Address - Country:US
Practice Address - Phone:530-885-0192
Practice Address - Fax:530-886-5959
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62492207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G624920Medicaid
CA00G624920Medicare PIN
CAB54514Medicare UPIN
CA00G624920Medicare ID - Type Unspecified