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Individual

LEE SELF

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2020 S JOHNS AVE STE B, EMMETT, ID 83617-9410
(208) 425-7507
(208) 541-9341
Mailing address
23000 SWEET OLA HWY, OLA, ID 83657-5027
(208) 880-4904
(208) 584-9341

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
M7844
ID
207VG0400X
Gynecology Physician
Primary
M7844
ID
207VX0000X
Obstetrics Physician
M7844
ID

Other

Enumeration date
05/17/2006
Last updated
11/12/2023
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