Provider Demographics
NPI:1104933704
Name:LEE, JONATHAN GLEN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:GLEN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BINZ ST
Mailing Address - Street 2:SUITE 1430
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-526-9986
Mailing Address - Fax:713-522-5200
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:#1430
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-526-9986
Practice Address - Fax:713-522-5200
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6883207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0021KGOtherBCBS
TX032146502Medicaid
200011476OtherRAILROAD MEDICARE
8J3472OtherBC
DA3051OtherRAILROAD MEDICARE
DA3051OtherRAILROAD MEDICARE
TXTXB143184Medicare PIN
E12500Medicare UPIN
TX00430VMedicare PIN