Basic Information
| Provider Information | |||||||||
| NPI: | 1245341049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | NAM | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5884 | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791175884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063517200 | ||||||||
| FaxNumber: | 8063517274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1411 E AMARILLO BLVD | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791075555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063517200 | ||||||||
| FaxNumber: | 8063517274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 01/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | E6471 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 133764410 | 05 | TX | MEDICAID | 8R5472 | 01 | TX | BCBS | OTHER |