Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | L3726 | TX |
NPI | 1023004413 |
---|---|
Provider Name | Justin T Lee |
First Address | Arlington, TX 76017-5993 |
Second Address | Arlington, TX 76017-5996 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 17/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150756801 | (05) | TX |
150756802 | (05) | TX |
150756803 | (05) | TX |
150756804 | MEDICAID OTHER (01) | TX |
150756805 | (05) | TX |
H56850 | (02) | TX |