Provider Demographics
NPI:1871500512
Name:SAN TAN FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:SAN TAN FAMILY MEDICINE PC
Other - Org Name:RONALD J LEE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-722-0252
Mailing Address - Street 1:2680 S VAL VISTA DR STE 114
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1606
Mailing Address - Country:US
Mailing Address - Phone:480-722-0252
Mailing Address - Fax:480-722-0253
Practice Address - Street 1:2680 S VAL VISTA DR STE 114
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1606
Practice Address - Country:US
Practice Address - Phone:480-722-0252
Practice Address - Fax:480-722-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ974271Medicaid
AZZ111305Medicare PIN