Provider Demographics
NPI:1760649321
Name:LEE, ALLEN B (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:B
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:410 N MALACATE ST
Mailing Address - Street 2:
Mailing Address - City:AJO
Mailing Address - State:AZ
Mailing Address - Zip Code:85321-2254
Mailing Address - Country:US
Mailing Address - Phone:520-387-5651
Mailing Address - Fax:520-387-6036
Practice Address - Street 1:483 SEED FARM RD.
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147-0038
Practice Address - Country:US
Practice Address - Phone:602-528-1200
Practice Address - Fax:602-528-1255
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ005174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005174OtherARIZONA STATE LICENSE