Provider Demographics
NPI:1851407662
Name:LEE, LAURA HAERYUN (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:HAERYUN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:ZEILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:677 N WILMOT ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-795-2889
Mailing Address - Fax:520-795-6321
Practice Address - Street 1:677 N WILMOT ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-795-2889
Practice Address - Fax:520-795-6321
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ346102085R0202X, 2085N0700X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ150824Medicaid
AZ1841261989OtherGROUP NPI
AZ1851407662OtherPHYSICIAN INDIVIDUAL NPI
AZP00435470OtherMEDICARE RAILROAD
AZZWCBBMOtherGROUP MEDICARE ID
AZ005472OtherGROUP MEDICAID ID
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN
AZZWCBBMOtherGROUP MEDICARE ID
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN