Provider Demographics
NPI:1801078159
Name:LEE, MARK YOUNG (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:YOUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:WILLIAM BEAUMONT ARMY MEDICAL CENTER, PLASTIC SURGERY C
Mailing Address - Street 2:18511 HIGHLANDER MEDICS ST.
Mailing Address - City:FORT BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79918
Mailing Address - Country:US
Mailing Address - Phone:808-388-2790
Mailing Address - Fax:915-569-0725
Practice Address - Street 1:WILLIAM BEAUMONT ARMY MEDICAL CENTER, PLASTIC SURGERY C
Practice Address - Street 2:18511 HIGHLANDER MEDICS ST.
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:808-388-2790
Practice Address - Fax:915-569-0725
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2022-07-13
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Provider Licenses
StateLicense IDTaxonomies
CAC170505208600000X, 2086S0122X
LA026278208600000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery