Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | MD.205962 | LA |
N | 2086S0122X | Plastic and Reconstructive Surgery | M7367 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD.205962 | LA |
NPI | 1265635866 |
---|---|
Provider Name | Michael Robert Lee |
First Address | Dallas, TX 75219-2315 |
Second Address | Dallas, TX 75219-2315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2007 |
Last Update Date | 09/05/2017 |