Individual
LAURA HAERYUN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
677 N WILMOT ROAD, TUCSON, AZ 85711
(520) 795-2889
(520) 795-6321
Mailing address
677 N WILMOT ROAD, TUCSON, AZ 85711
(520) 795-2889
(520) 795-6321
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
34610
AZ
2085R0202X
Diagnostic Radiology Physician
Primary
34610
AZ
2085U0001X
Diagnostic Ultrasound Physician
34610
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005472
GROUP MEDICAID ID
AZ
05
—
150824
—
AZ
01
—
1841261989
GROUP NPI
AZ
01
—
1851407662
PHYSICIAN INDIVIDUAL NPI
AZ
01
—
CS7943
GROUP MEDICARE RAILROAD ID & PTAN
AZ
01
—
P00435470
MEDICARE RAILROAD
AZ
01
—
ZWCBBM
GROUP MEDICARE ID
AZ
Enumeration date
08/22/2006
Last updated
02/27/2013
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