Provider Demographics
NPI:1154389344
Name:LEE, JOHN REED (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:REED
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 1:5204 WEST REDBUD STREET
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758
Mailing Address - Country:US
Mailing Address - Phone:479-636-0110
Mailing Address - Fax:479-631-0491
Practice Address - Street 1:5204 W REDBUD ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8936
Practice Address - Country:US
Practice Address - Phone:479-636-0110
Practice Address - Fax:479-631-0491
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7114207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K875Medicare ID - Type Unspecified
AR134757001Medicaid
ARG74526Medicare UPIN