Individual
ROBERT LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01048726A
IN
207WX0107X
Retina Specialist (Ophthalmology) Physician
01048726A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000093609
BLUE SHIELD
IN
01
—
000000550384
ANTHEM
IN
05
—
200182540
—
IN
05
—
200883090A
—
IN
05
—
4134100
—
MI
Enumeration date
07/21/2005
Last updated
07/12/2017
Update your record
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