Provider Demographics
NPI:1548389240
Name:LEE, CHRISTOPHER MARCUS (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARCUS
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
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 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:580-242-3870
Mailing Address - Fax:
Practice Address - Street 1:615 E OKLAHOMA AVE STE 203
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5952
Practice Address - Country:US
Practice Address - Phone:580-242-3870
Practice Address - Fax:580-242-4046
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4089207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200023880AMedicaid
OKI00484Medicare UPIN
OK200023880AMedicaid