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Individual

LEE A ANTLES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
9040 JACKSON AVENUE, TACOMA, WA 98431-8151
(253) 968-2462
Mailing address
9040 JACKSON AVENUE, TACOMA, WA 98431-0001
(253) 968-2462

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00025946
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0168090
LABOR & INDUSTRIES
WA
01
110245917
RAILROAD MEDICARE UPIN
01
GAB34522
MEDICARE PTAN
Enumeration date
07/07/2005
Last updated
03/20/2019
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