Provider Demographics
NPI:1598703605
Name:LEE, PHILIP D (CRNA)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:D
Last Name:LEE
Suffix:
Gender:M
Credentials:CRNA
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 55059
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5059
Mailing Address - Country:US
Mailing Address - Phone:256-764-9697
Mailing Address - Fax:256-764-9699
Practice Address - Street 1:1400 MCFARLAND BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2209
Practice Address - Country:US
Practice Address - Phone:205-345-5500
Practice Address - Fax:205-502-5152
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-083081367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP45715Medicare UPIN
AL051518297Medicare ID - Type Unspecified