Provider Demographics
NPI:1891151684
Name:LEE, STEPHEN EMERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EMERSON
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 SHORELINE WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-2840
Mailing Address - Country:US
Mailing Address - Phone:805-985-6889
Mailing Address - Fax:
Practice Address - Street 1:4951 SHORELINE WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-2840
Practice Address - Country:US
Practice Address - Phone:805-985-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-323622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-22559Medicare UPIN