Provider Demographics
NPI:1407891666
Name:ROOF, LEE WHITNEY (MD)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:WHITNEY
Last Name:ROOF
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:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239
Mailing Address - Country:US
Mailing Address - Phone:360-678-4440
Mailing Address - Fax:360-678-9244
Practice Address - Street 1:77 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239
Practice Address - Country:US
Practice Address - Phone:360-678-4440
Practice Address - Fax:360-678-9244
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAM000018926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9239923Medicaid
A09017Medicare UPIN
WA9239923Medicaid