Provider Demographics
NPI:1427051259
Name:VRANNA, LEE EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:EUGENE
Last Name:VRANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEE
Other - Middle Name:EUGENE
Other - Last Name:VRANNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 13129
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-1129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:890 OAK ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-814-4732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58584225400000X
ORMD16161225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G585840Medicaid
CA00G585840Medicare ID - Type UnspecifiedMEDICARE
CA00G585840Medicaid