Provider Demographics
NPI:1710148705
Name:LEE, EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 B ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5925
Mailing Address - Country:US
Mailing Address - Phone:907-375-3357
Mailing Address - Fax:907-375-3351
Practice Address - Street 1:4300 B ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5925
Practice Address - Country:US
Practice Address - Phone:907-375-3357
Practice Address - Fax:907-375-3351
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52280207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04-13613OtherMEDICA
MNP00792448OtherRR MEDICARE
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MN04-13613OtherMEDICA
MN110013171Medicare PIN