Provider Demographics
NPI:1962494484
Name:LEE, MAXIMILIAN SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIMILIAN
Middle Name:SAMUEL
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:RAF LAKENHEATH 48 MDG/SGHC
Mailing Address - Street 2:UNIT 5115
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09461-5115
Mailing Address - Country:US
Mailing Address - Phone:314-226-8124
Mailing Address - Fax:
Practice Address - Street 1:811 GRIER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3704
Practice Address - Country:US
Practice Address - Phone:800-779-0526
Practice Address - Fax:800-779-0526
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5019207P00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine