Provider Demographics
NPI:1477623445
Name:LEE, HOWARD (MD)
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 TARA HILLS DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564
Mailing Address - Country:US
Mailing Address - Phone:510-724-1650
Mailing Address - Fax:510-724-6322
Practice Address - Street 1:1320 TARA HILLS DR
Practice Address - Street 2:SUITE I
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564
Practice Address - Country:US
Practice Address - Phone:510-724-1650
Practice Address - Fax:510-724-6322
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG200992086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G200991Medicaid
CA00G200990Medicare ID - Type Unspecified
CA00G200991Medicaid