Provider Demographics
NPI:1649435249
Name:LEE, JOE WILLIAM III (LMP)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:WILLIAM
Last Name:LEE
Suffix:III
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 S MERIDIAN APT 522
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1597
Mailing Address - Country:US
Mailing Address - Phone:253-507-0870
Mailing Address - Fax:
Practice Address - Street 1:1310 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3928
Practice Address - Country:US
Practice Address - Phone:252-507-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024918174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist