Provider Demographics
NPI:1245090075
Name:LEE, BU SUB (DO)
Entity type:Individual
Prefix:
First Name:BU SUB
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MARCUS
Other - Middle Name:BUSUB
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:531 BROAD AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1755
Mailing Address - Country:US
Mailing Address - Phone:201-962-0431
Mailing Address - Fax:
Practice Address - Street 1:2221 NE 139TH STREET
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686
Practice Address - Country:US
Practice Address - Phone:360-397-1985
Practice Address - Fax:360-604-1604
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program