Provider Demographics
NPI:1720094675
Name:LEE, DONALD D (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:D
Last Name:LEE
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 1:11311 BRIDGEPORT WAY SW STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3051
Mailing Address - Country:US
Mailing Address - Phone:253-985-6688
Mailing Address - Fax:360-825-6536
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3051
Practice Address - Country:US
Practice Address - Phone:253-985-6688
Practice Address - Fax:360-825-6536
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1045401Medicaid
WA8939486OtherSTATE CRIME VICTIMS
WAP00185519OtherMEDICARE RAILROAD
WA0226778OtherSTATE L&I
WA0191652OtherSTATE L&I
WA0217716OtherSTATE L&I
WA8242976Medicaid
WA8943818OtherSTATE CRIME VICTIMS
8850500Medicare ID - Type Unspecified
WAG8864881Medicare PIN
WA8939486OtherSTATE CRIME VICTIMS
WAG8850500Medicare PIN