Provider Demographics
NPI:1831169598
Name:PARSONS, LEE W (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:W
Last Name:PARSONS
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:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-955-6500
Mailing Address - Fax:208-955-6501
Practice Address - Street 1:5601 W CHINDEN BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-1463
Practice Address - Country:US
Practice Address - Phone:208-809-2865
Practice Address - Fax:208-809-2866
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM5974207V00000X
IDM-5974207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010003851OtherREGENCE BLUE SHIELD OF ID
ID003885000Medicaid
ID33092OtherBLUE CROSS OF ID
OR121074Medicaid
ID003885000Medicaid
IDF57195Medicare UPIN
ID160028300Medicare ID - Type UnspecifiedRAILROAD MEDICARE