Provider Demographics
NPI:1942249438
Name:LEE, AUGUSTINE J (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:J
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 1:711 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2208
Mailing Address - Country:US
Mailing Address - Phone:970-641-7264
Mailing Address - Fax:970-642-4795
Practice Address - Street 1:711 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2208
Practice Address - Country:US
Practice Address - Phone:970-641-1456
Practice Address - Fax:970-642-4795
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148933208C00000X
TXL6097208600000X
CODR.0069824208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110215400Medicaid
TX612042Medicare PIN