Provider Demographics
NPI:1689697872
Name:LEE, PAUL SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SAMUEL
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 1:1340 HAL GREER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3804
Mailing Address - Country:US
Mailing Address - Phone:304-522-3420
Mailing Address - Fax:304-529-4645
Practice Address - Street 1:1660 12TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3833
Practice Address - Country:US
Practice Address - Phone:304-522-3420
Practice Address - Fax:304-529-4645
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19474207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100466070Medicaid
OH0204126Medicaid
WV1689697872Medicaid
WV0093852000Medicaid