Provider Demographics
NPI:1972664761
Name:LEE, ROBERT PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ROCK POINT DRIVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7727
Mailing Address - Country:US
Mailing Address - Phone:970-247-3717
Mailing Address - Fax:970-247-3806
Practice Address - Street 1:150 ROCK POINT DRIVE
Practice Address - Street 2:UNIT C
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7727
Practice Address - Country:US
Practice Address - Phone:970-247-3717
Practice Address - Fax:970-247-3806
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30313208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E38888Medicare UPIN
CO12192Medicare ID - Type Unspecified