Provider Demographics
NPI:1891724472
Name:LEE, GARRETT B
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:B
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GARRETT
Other - Middle Name:B
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2000 BOISE AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5006
Mailing Address - Country:US
Mailing Address - Phone:970-635-4071
Mailing Address - Fax:970-820-4177
Practice Address - Street 1:2000 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5006
Practice Address - Country:US
Practice Address - Phone:970-635-4071
Practice Address - Fax:970-820-4177
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78487207P00000X
CO49745207P00000X
CODR.0049745207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01370847OtherRAILROAD MEDICARE PIN
CA00G784870Medicaid
CO00120740Medicaid
CO00120740Medicaid
CO312416YUQWMedicare PIN
G39833Medicare UPIN
CA00G784870Medicare PIN