Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | AP144004 | TX |
NPI | 1225609712 |
---|---|
Provider Name | Allison Lee |
First Address | Fort Worth, TX 76132-3119 |
Second Address | Fort Worth, TX 76132-3119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2021 |
Last Update Date | 06/07/2021 |