Provider Demographics
NPI:1821032962
Name:LEE, CHRISTOPHER ELLIOT
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ELLIOT
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3798 JANES RD STE 18
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4746
Mailing Address - Country:US
Mailing Address - Phone:707-822-0384
Mailing Address - Fax:707-822-4429
Practice Address - Street 1:3798 JANES RD STE 18
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4746
Practice Address - Country:US
Practice Address - Phone:707-822-0384
Practice Address - Fax:707-822-4429
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31361207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G313610Medicaid
CA00G313610Medicaid
CA00G313610Medicare PIN