Provider Demographics
NPI:1962484113
Name:YEE, GREGORY JEN-LEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JEN-LEN
Last Name:YEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:JEN-LEN
Other - Last Name:YI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-2411
Mailing Address - Fax:515-239-2492
Practice Address - Street 1:1111 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-239-2411
Practice Address - Fax:515-239-2492
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA272782085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0058883Medicaid
IA0058883Medicaid
IAE24260Medicare UPIN