Provider Demographics
NPI:1801957915
Name:LEE, ROBERT GARY (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GARY
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:GARY
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 S WENONA ST
Mailing Address - Street 2:SUITE G-96
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-8820
Mailing Address - Country:US
Mailing Address - Phone:989-894-2949
Mailing Address - Fax:989-894-5848
Practice Address - Street 1:200 S WENONA ST
Practice Address - Street 2:SUITE G-96
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8820
Practice Address - Country:US
Practice Address - Phone:989-894-2949
Practice Address - Fax:989-894-5848
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRL208675174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist