Provider Demographics
NPI:1649234527
Name:LEE, CARMA J (MD)
Entity Type:Individual
Prefix:
First Name:CARMA
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMA
Other - Middle Name:J
Other - Last Name:HENDRIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 92900
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0900
Mailing Address - Country:US
Mailing Address - Phone:503-666-6717
Mailing Address - Fax:
Practice Address - Street 1:5835 NE 122ND AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1057
Practice Address - Country:US
Practice Address - Phone:503-251-6301
Practice Address - Fax:503-261-6080
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8438582Medicaid
OR287489Medicaid
WA8438582Medicaid
ORR106328Medicare PIN