Provider Demographics
NPI:1982817037
Name:GLASS, LEE S (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:S
Last Name:GLASS
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 1:9608 SE 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3704
Mailing Address - Country:US
Mailing Address - Phone:206-232-3982
Mailing Address - Fax:206-232-3982
Practice Address - Street 1:9608 SE 40TH ST
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3704
Practice Address - Country:US
Practice Address - Phone:206-232-3982
Practice Address - Fax:206-232-3982
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023232209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes209800000XAllopathic & Osteopathic PhysiciansLegal Medicine