Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | 3864 | OK |
Y | 207Q00000X | Family Doctor | 5586 | OK |
NPI | 1295911287 |
---|---|
Provider Name | Brian Spencer Lee |
First Address | Durant, OK 74701-2292 |
Second Address | Durant, OK 74701-2292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2008 |
Last Update Date | 17/03/2018 |