| Dr Russell D Lee, MD | |
|
15 S Main St, Suite 170, Jamestown, NY 14701-6626 | |
| (716) 483-1183 | |
| (716) 664-4903 |
| Full Name | Dr Russell D Lee |
|---|---|
| Gender | Male |
| Speciality | Surgery |
| Location | 15 S Main St, Jamestown, New York |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972573277 | NPI | - | NPPES |
| 03338612 | Medicaid | NY | |
| J400168929 | Other | NY | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | 258146 (New York) | Primary |
| Entity Name | Great Lakes Physician Practice Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1730599176 PECOS PAC ID: 6709007701 Enrollment ID: O20141016000108 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Russell D Lee, MD 15 S Main St, Suite 300, Jamestown, NY 14701-6626 Ph: (716) 483-1183 | Dr Russell D Lee, MD 15 S Main St, Suite 170, Jamestown, NY 14701-6626 Ph: (716) 483-1183 |
Timothy Brown, Surgery Medicare: Accepting Medicare Assignments Practice Location: 15 S Main St, Suite 170, Jamestown, NY 14701 Phone: 716-483-1183 | |
Dr. Galo A Grijalva, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 207 Foote Ave, Jamestown, NY 14701 Phone: 716-485-7870 Fax: 716-485-7878 | |
Bert W Rappole, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 15 S Main St, Suite 170, Jamestown, NY 14701 Phone: 716-483-1183 Fax: 716-483-2445 | |
Scott H Bedwell, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 15 S Main St Ste 170, Jamestown, NY 14701 Phone: 716-483-1183 Fax: 716-483-2445 | |
George W Conner, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 17 Sherman St, Jamestown, NY 14701 Phone: 716-484-0173 Fax: 716-484-0177 | |
Dr. Matthew S Chang, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 15 S Main St, Suite 170, Jamestown, NY 14701 Phone: 716-483-1183 |