Individual
BRYAN W LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
350 W THOMAS RD, PHOENIX, AZ 85013-4409
(602) 274-4484
(602) 287-9406
Mailing address
300 W CLARENDON AVE STE 350, PHOENIX, AZ 85013-3497
(602) 274-4484
(602) 287-9406
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1626
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007049
NCCPA CERTIFICATE
AZ
Enumeration date
03/20/2007
Last updated
04/06/2011
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