Provider Demographics
NPI:1679633382
Name:LEE, RONALD D (DPM)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:D
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
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 1129
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-1129
Mailing Address - Country:US
Mailing Address - Phone:319-754-8996
Mailing Address - Fax:319-754-2177
Practice Address - Street 1:102 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5403
Practice Address - Country:US
Practice Address - Phone:319-754-8996
Practice Address - Fax:319-754-2177
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA410213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0210583Medicaid
IA0192900002Medicare NSC
T01195Medicare UPIN
IA21058Medicare PIN