Provider Demographics
NPI:1013937663
Name:LEE, MARTIN MAO-TING (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:MAO-TING
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARTIN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:702 23RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4661
Mailing Address - Country:US
Mailing Address - Phone:253-841-4378
Mailing Address - Fax:
Practice Address - Street 1:702 23RD AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4661
Practice Address - Country:US
Practice Address - Phone:253-841-4378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5834656-1205207RC0200X
WAMD60127504207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT902460OtherDMBA
UT239024OtherALTIUS
UT870281028000Medicaid
UTP00299426OtherPALMETTO
UT76-00071OtherUNITED HEALTHCARE
UT107038443101OtherIHC
UT83555OtherPEHP
UT870281028LEEOtherEMIA
UT239024OtherALTIUS