Provider Demographics
NPI:1740283407
Name:LEE, WAYLAND SHERROD (MD)
Entity type:Individual
Prefix:DR
First Name:WAYLAND
Middle Name:SHERROD
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 1:904 SW BAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4860
Mailing Address - Country:US
Mailing Address - Phone:541-574-4677
Mailing Address - Fax:541-574-4663
Practice Address - Street 1:904 SW BAY ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4860
Practice Address - Country:US
Practice Address - Phone:541-574-4677
Practice Address - Fax:541-574-4663
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10109207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0189210OtherPROVIDER NUMBER
OR022791Medicaid
OR022791Medicaid
WA0189210OtherPROVIDER NUMBER