Provider Demographics
NPI:1902013915
Name:LEE, CHARLES DUDLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DUDLEY
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 1:16643 MAVERICK LN
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-1613
Mailing Address - Country:US
Mailing Address - Phone:831-206-8547
Mailing Address - Fax:
Practice Address - Street 1:16643 MAVERICK LN
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-1613
Practice Address - Country:US
Practice Address - Phone:831-206-8547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG230952085R0202X
FLME793692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology