Provider Demographics
NPI:1629148994
Name:LEE, BRUCE BERNARD (MD)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:BERNARD
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:966 CASS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940
Mailing Address - Country:US
Mailing Address - Phone:831-649-1144
Mailing Address - Fax:831-649-3529
Practice Address - Street 1:966 CASS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-649-1144
Practice Address - Fax:831-649-3529
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49085207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G490850Medicaid
OOG490850Medicare ID - Type Unspecified
CA00G490850Medicaid