Provider Demographics
NPI:1104930312
Name:LEE, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:5400 KELL WEST BLVD
Practice Address - Street 2:TEXOMA CANCER CENTER
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1610
Practice Address - Country:US
Practice Address - Phone:940-691-8271
Practice Address - Fax:940-692-2042
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG35472085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127964809Medicaid
OK200057390AMedicaid
TX127964810Medicaid
TX127964809Medicaid
OK200057390AMedicaid
TXP00448895Medicare PIN