Provider Demographics
NPI:1891822425
Name:LEE, HAROLD G (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:G
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 1:10101 SE MAIN ST STE 2016
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2457
Mailing Address - Country:US
Mailing Address - Phone:503-253-3882
Mailing Address - Fax:503-253-2848
Practice Address - Street 1:10101 SE MAIN ST STE 2016
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2457
Practice Address - Country:US
Practice Address - Phone:503-253-3882
Practice Address - Fax:503-253-2848
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14393208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR135657Medicaid
ORMD14393OtherOREGON MEDICAL LICENSE
ORR134351OtherMEDICARE
ORR134351OtherMEDICARE
ORMD14393OtherOREGON MEDICAL LICENSE