Lee Self MD PA

NPI #1346400744 in Emmett, Idaho

Provider Information

NPI Number: 1346400744
Entity Type: Organization
Organization Name: Lee Self MD PA
Primary Specialty: Specialist
Enumeration Date: Jun 10, 2008
Last Updated: Mar 24, 2023

Practice Location

Address: 2020 S JOHNS AVE STE B
City: Emmett
State: Idaho
ZIP Code: 83617-9410
Phone: (208) 425-7507

Authorized Official

Name: LEE SELF, MD
Title: PRESIDENT
Phone: (208) 425-7507

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Primary Care — Primary Care	261QP2300X
Specialist	174400000X	Primary

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