Provider Demographics
NPI:1730265596
Name:LEE, GERALD W (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:W
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-8758
Mailing Address - Country:US
Mailing Address - Phone:360-748-0211
Mailing Address - Fax:
Practice Address - Street 1:1299 BISHOP RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-8758
Practice Address - Country:US
Practice Address - Phone:360-748-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0271861OtherLABOR AND INDUSTRIES
276490OtherINTERNAL ID-MOTOR VEHICLE ID
WA0344LEOtherREGENCE
WA8396038Medicaid
WA271861OtherLNI
WA1730265596Medicaid
WA0271861OtherLABOR AND INDUSTRIES
I08333Medicare UPIN
WA1730265596Medicaid
WA8804401Medicare PIN