Provider Demographics
NPI:1841299047
Name:LEE, RODNEY JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:JOHN
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 1:1002 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560
Mailing Address - Country:US
Mailing Address - Phone:701-630-9536
Mailing Address - Fax:888-959-2798
Practice Address - Street 1:1002 1ST AVE N
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:701-630-9536
Practice Address - Fax:888-959-2798
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41391207Q00000X
ND7790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN082815700Medicaid
G51514Medicare UPIN
G51514Medicare UPIN