Lee Self MD PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

M7844 Issued in ID

Legal business name

LEE SELF MD PA

Practice address

2020 S Johns Ave Ste B
Emmett, ID 83617-9410

Phone

(208) 425-7507

Fax

(208) 584-9341

NPI assigned

Jun 10, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lee Self, MDNPI 1639121361

Title

President

Phone

(208) 425-7507

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lee Self, MD

  • Gynecology Physician
  • Emmett, ID
  • NPI 1639121361
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679616000000",
    "number": "1346400744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23000 SWEET OLA HWY",
            "city": "OLA",
            "state": "ID",
            "postal_code": "836575027",
            "telephone_number": "208-425-7507",
            "fax_number": "208-584-9341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 S JOHNS AVE STE B",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836179410",
            "telephone_number": "208-425-7507",
            "fax_number": "208-584-9341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEE SELF MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-425-7507",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "ID",
            "license": "M7844",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peggy Knodel, LMFT
• Randi Jo Korell, MS LCPC
• Tara Landis, LCSW
• Danielle Dominique Langley
• Valerie Lawrence, RDN
• Jackie Legg
• Jessica Anne Logan
• Lawren Long, LCSW
• Jason Loveless, P.T., D.P.T., NCS
• Shelly Mae Lummus

• Specialist in Emmett, ID
• Providers in Emmett, ID by specialty
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.