Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 23777 | TX |
N | 1223G0001X | General Practice | 22DI02264400 | NJ |
N | 213EG0000X | General Practice | 22DI02264400 | NJ |
N | 1223G0001X | General Practice | 2901019436 | MI |
N | 213EG0000X | General Practice | 2901019436 | MI |
N | 1223G0001X | General Practice | DS035851 | PA |
N | 213EG0000X | General Practice | DS035851 | PA |
NPI | 1164417267 |
---|---|
Provider Name | Dr. John S Lee |
First Address | Coppell, TX 75019-4539 |
Second Address | Coppell, TX 75019-4539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 04/05/2009 |