Provider Demographics
NPI:1639582356
Name:LEE, CAITLIN MOLLOY (DO)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:MOLLOY
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 12TH ST STE 605
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2850
Mailing Address - Country:US
Mailing Address - Phone:602-839-2668
Mailing Address - Fax:602-839-2067
Practice Address - Street 1:1300 N 12TH ST STE 605
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2850
Practice Address - Country:US
Practice Address - Phone:602-839-2668
Practice Address - Fax:602-839-2067
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR2375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine