Provider Demographics
NPI:1548268451
Name:LEE, JULIA M (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7058
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-0018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:353 W DRAKE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2865
Practice Address - Country:US
Practice Address - Phone:303-469-7300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12579556Medicaid
CO7449001OtherAETNA PIN
COLE636893OtherANTHEM BC/BS
COG58020Medicare UPIN
CO12579556Medicaid