Provider Demographics
NPI:1558386045
Name:LEE-VALKOV, PAULA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:MARIA
Last Name:LEE-VALKOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E 2ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1736
Mailing Address - Country:US
Mailing Address - Phone:541-298-8718
Mailing Address - Fax:541-298-1184
Practice Address - Street 1:1700 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3317
Practice Address - Country:US
Practice Address - Phone:541-296-7251
Practice Address - Fax:541-296-7615
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD257852085R0202X
WAMD000445792085R0202X
CAA904762085R0202X
LAL#0261462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology