Provider Demographics
NPI:1962498709
Name:LEE, MARC L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1010 E MCDOWELL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2609
Mailing Address - Country:US
Mailing Address - Phone:602-251-3122
Mailing Address - Fax:602-254-1226
Practice Address - Street 1:1010 E MCDOWELL RD STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2609
Practice Address - Country:US
Practice Address - Phone:602-251-3122
Practice Address - Fax:602-254-1226
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
738514OtherHUMANA
AZAZ0883590OtherBLUE CROSS BLUE SHIELD
738514OtherHUMANA
E00236Medicare UPIN