Provider Demographics
NPI:1912909623
Name:SECRIST, LEE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:J
Last Name:SECRIST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:3754 S BRENTWOOD LN
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-7053
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2013-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM77312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology