Provider Demographics
NPI:1952164071
Name:LEE, LAWRENCE A
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:A
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14415 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-8805
Mailing Address - Country:US
Mailing Address - Phone:763-291-7120
Mailing Address - Fax:
Practice Address - Street 1:14415 TYLER AVE
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-8805
Practice Address - Country:US
Practice Address - Phone:763-291-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver