Provider Demographics
NPI:1760481808
Name:LEE, ERIC C (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:C
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 1:1238 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4951
Mailing Address - Country:US
Mailing Address - Phone:909-982-0099
Mailing Address - Fax:909-931-0402
Practice Address - Street 1:1238 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4951
Practice Address - Country:US
Practice Address - Phone:909-982-0099
Practice Address - Fax:909-931-0402
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0091870Medicaid
CAH56234Medicare UPIN
CAGR0091870Medicaid