Basic Information
| Provider Information | |||||||||
| NPI: | 1760649321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | ALLEN | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 N MALACATE ST | ||||||||
| Address2: | |||||||||
| City: | AJO | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853212254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203875651 | ||||||||
| FaxNumber: | 5203876036 | ||||||||
| Practice Location | |||||||||
| Address1: | 483 SEED FARM RD. | ||||||||
| Address2: | |||||||||
| City: | SACATON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851470038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025281200 | ||||||||
| FaxNumber: | 6025281255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 10/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 005174 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 005174 | 01 | AZ | ARIZONA STATE LICENSE | OTHER |