Provider Demographics
NPI: | 1760466981 |
---|---|
Name: | LEE, GARRETT (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | GARRETT |
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: | 450 STANYAN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN FRANCISCO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94117-1079 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 415-750-5531 |
Mailing Address - Fax: | 415-750-5948 |
Practice Address - Street 1: | 450 STANYAN ST |
Practice Address - Street 2: | |
Practice Address - City: | SAN FRANCISCO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94117-1079 |
Practice Address - Country: | US |
Practice Address - Phone: | 415-750-5531 |
Practice Address - Fax: | 415-750-5948 |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2005-12-01 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | G26137 | 207R00000X, 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
Not Answered | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
A42916 | Medicare UPIN | ||
CA | 00G261370 | Medicare ID - Type Unspecified |