Organization
LEE SELF MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE SELF MD (PRESIDENT)
(208) 425-7507
Entity
Organization
Contact information
Practice address
2020 S JOHNS AVE STE B, EMMETT, ID 83617-9410
(208) 425-7507
(208) 584-9341
Mailing address
23000 SWEET OLA HWY, OLA, ID 83657-5027
(208) 425-7507
(208) 584-9341
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M7844
ID
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
06/10/2008
Last updated
03/24/2023
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