Individual
BRIAN J LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7910 W JEFFERSON BLVD STE 212, FORT WAYNE, IN 46804-4159
(260) 427-7473
(260) 432-3189
Mailing address
7910 W JEFFERSON BLVD STE 212, FORT WAYNE, IN 46804-4159
(260) 427-7473
(260) 432-3189
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
01040298A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0984010
—
OH
05
—
100372020
—
IN
05
—
104366796
—
MI
01
—
240007525
MEDICARE RAILROAD
IN
Enumeration date
08/10/2005
Last updated
03/06/2012
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