Evan W. Lee Jr., D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

DOS-997 Issued in HI

Practice address

645 E 5TH St
Weiser, ID 83672-2202

Phone

(208) 549-0370

NPI assigned

Nov 17, 2006

Last updated

Aug 26, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Weiser Valley Hospital District

  • Family Medicine Physician
  • Weiser, ID
  • NPI 1255364030
  Medicare reassignment NPD
• Weiser Valley Hospital District

  dba Weiser Memorial Hospital

  • Critical Access Hospital
  • Weiser, ID
  • NPI 1881641629
  Medicare reassignment
• Weiser Valley Hospital District

  • Critical Access Hospital
  • Boise, ID
  • NPI 1639373772
  NPD
• Weiser Valley Hospital District

  • Specialist
  • Weiser, ID
  • NPI 1932650561
  NPD
• Weiser Valley Hospital District

  • Critical Access Hospital
  • Weiser, ID
  • NPI 1720282866
  NPD (past)

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1740353432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 W ESCALANTE DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836164470",
            "telephone_number": "808-651-8846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 E 5TH ST",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836722202",
            "telephone_number": "208-549-0370"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 W Fort St",
            "address_2": "# 111",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "83702",
            "country_code": "US",
            "telephone_number": "208-422-1000",
            "fax_number": "208-422-1319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "EVAN",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "HI",
            "license": "DOS-997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHA",
            "identifier": "111156",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "538332 01",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA",
            "identifier": "0000242321",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven G Iwasa, O.D.
• Tyler Jue, NP
• Kindred Nursing Centers West, LLC (Kindred Nursing and Rehabilitation - Weiser)
• Michael Lafferty, PTA
• Audrey Mae Lande, COTA/L
• Kayla Lo, FNP-C
• Karen Rene Lockwood, COTA/L
• Christopher Earl Malloy, DMD
• Vanyssa Marble, B.S.
• Sarah Anne Martin, FNP

• Emergency Medicine Physician in Weiser, ID
• Providers in Weiser, ID by specialty
• Emergency Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.