Individual
LEE A ANTLES
Active
Individual
LEE A ANTLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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