Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | J9154 | TX |
N | 208000000X | Pediatrician | J9154 | TX |
NPI | 1114007515 |
---|---|
Provider Name | Dr. Brendan Lee |
First Address | Houston, TX 77030-2316 |
Second Address | Houston, TX 77030-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129764004 | (05) | TX |
G65906 | (02) |