Provider Demographics
NPI:1568534741
Name:LEE, JOHN J (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3101 N CENTRAL AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2635
Mailing Address - Country:US
Mailing Address - Phone:602-230-7373
Mailing Address - Fax:
Practice Address - Street 1:3033 N CENTRAL AVE STE 700
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2806
Practice Address - Country:US
Practice Address - Phone:602-230-7373
Practice Address - Fax:602-257-8029
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ41502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ980830Medicaid
AZI49056Medicare UPIN
AZ107862Medicare PIN