1962403105 NPI number — ANDREW G LEE MD

Table of content: ANDREW G LEE MD (NPI 1962403105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962403105 NPI number — ANDREW G LEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
ANDREW
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962403105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6560 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE 450
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-441-8843
Provider Business Mailing Address Fax Number:
713-441-6463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6560 FANNIN ST
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-441-8843
Provider Business Practice Location Address Fax Number:
713-441-6463
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  33357 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: J7048 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00782064 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01063017 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 125175306 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16243 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 8BZ089 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 125175305 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0206417 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8DZ190 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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