Basic Information
| Provider Information | |||||||||
| NPI: | 1801850201 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4144 N CENTRAL EXPY | ||||||||
| Address2: | STE 750 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752043208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143031033 | ||||||||
| FaxNumber: | 2143031032 | ||||||||
| Practice Location | |||||||||
| Address1: | 4144 N CENTRAL EXPY | ||||||||
| Address2: | STE 750 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143031033 | ||||||||
| FaxNumber: | 2143031032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 07/19/2018 | ||||||||
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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 | 207R00000X | L0853 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8S1640 | 01 | TX | BC/BS | OTHER | 151138804 | 05 | TX | MEDICAID |