Provider Demographics
NPI:1285614693
Name:LEE, THOMAS WAY (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WAY
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:930 E FOOTHILL BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-946-2277
Mailing Address - Fax:909-920-0765
Practice Address - Street 1:930 E FOOTHILL BLVD
Practice Address - Street 2:STE 2
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-946-2277
Practice Address - Fax:909-920-0765
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25725207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA257250Medicaid
CAOOA257250Medicare ID - Type Unspecified
CAOOA257250Medicaid