Provider Demographics
NPI:1851769491
Name:LEE, AUSTIN (PA)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2535 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-519-4333
Mailing Address - Fax:208-205-9134
Practice Address - Street 1:2535 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1308
Practice Address - Country:US
Practice Address - Phone:208-519-4333
Practice Address - Fax:208-205-9134
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2024-04-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant