Provider Demographics
NPI:1255358891
Name:LEE, JOSEPH CLARK (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CLARK
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 1:11511 RED ROCK RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5318
Mailing Address - Country:US
Mailing Address - Phone:414-758-0591
Mailing Address - Fax:231-922-4030
Practice Address - Street 1:11511 RED ROCK RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5318
Practice Address - Country:US
Practice Address - Phone:414-758-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45459207P00000X
IN02002087A207P00000X
IL036-102964207P00000X
OK5495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43506300Medicaid
WI0004Medicare PIN
WI43506300Medicaid
H62086Medicare UPIN
WI001201473Medicare PIN