Provider Demographics
NPI:1760826937
Name:LEE, DELORES JOHANNE (MD)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:JOHANNE
Last Name:LEE
Suffix:
Gender:F
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:PO BOX CU
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-7623
Mailing Address - Country:US
Mailing Address - Phone:671-483-3060
Mailing Address - Fax:
Practice Address - Street 1:655 HARMON LOOP RD STE 108
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6544
Practice Address - Country:US
Practice Address - Phone:671-633-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine