Provider Demographics
NPI:1558313866
Name:LEE, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
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:PO BOX 853
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-0853
Mailing Address - Country:US
Mailing Address - Phone:907-745-0374
Mailing Address - Fax:907-745-0200
Practice Address - Street 1:2500 S WOODWORTH LOOP
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8984
Practice Address - Country:US
Practice Address - Phone:907-745-0374
Practice Address - Fax:907-745-0200
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2913207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK020257499OtherGROUPS ENERGY EMP#
AK193975000OtherGROUPS FED DEPT LABOR#
AKMD01001Medicaid
AK050067817OtherLEE RAILROAD MCR#
AKCI9459OtherGROUPS RAILROAD MCR#
AKMDG417Medicaid
AK150657Medicare ID - Type UnspecifiedGROUPS MCR#
AK020257499OtherGROUPS ENERGY EMP#
AKCI9459OtherGROUPS RAILROAD MCR#