Provider Demographics
NPI:1689619900
Name:LEE, MARCUS F (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:F
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 NORTH HOLLYWOOD WAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-5019
Mailing Address - Country:US
Mailing Address - Phone:818-557-0135
Mailing Address - Fax:818-557-1394
Practice Address - Street 1:1401 GARCES HIGHWAY
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3690
Practice Address - Country:US
Practice Address - Phone:661-721-5262
Practice Address - Fax:661-721-5254
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43348207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43348OtherBLUE CROSS
CA00A433480Medicaid
CA00A433480OtherCALOPTIMA
CA050608CE92843OtherDELANO TRAILBLAZER
CA00A433480OtherBLUE SHIELD
CA00A433485Medicare ID - Type UnspecifiedDELANO REGIONAL MED CTR
CA00A433480OtherBLUE SHIELD