Provider Demographics
NPI:1174916720
Name:LEE, DAVID FAY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FAY
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9601 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548
Mailing Address - Country:US
Mailing Address - Phone:715-358-1355
Mailing Address - Fax:715-358-1897
Practice Address - Street 1:9601 TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548
Practice Address - Country:US
Practice Address - Phone:715-358-1355
Practice Address - Fax:715-358-1897
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63327-202085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology