Provider Demographics
NPI:1619104924
Name:LEE, ERIC T (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
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 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:360-782-3600
Mailing Address - Fax:
Practice Address - Street 1:2011 NW MYHRE PL
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8561
Practice Address - Country:US
Practice Address - Phone:360-830-1605
Practice Address - Fax:360-830-1693
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP609083242084N0400X
SCLL4758207R00000X
NC16191049242084N0400X
ORDO1650532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine