Provider Demographics
NPI:1225184906
Name:LEE, JENNY (MD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 PARKER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2285
Mailing Address - Country:US
Mailing Address - Phone:719-564-1544
Mailing Address - Fax:
Practice Address - Street 1:3670 PARKER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2285
Practice Address - Country:US
Practice Address - Phone:719-564-1544
Practice Address - Fax:719-924-1593
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO43172207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00986961OtherRAILROAD MEDICARE
CO41672381Medicaid
COCOAAA1704Medicare PIN