Provider Demographics
NPI:1194542613
Name:DOERNTE, LEE A (PHD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:A
Last Name:DOERNTE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4727
Mailing Address - Country:US
Mailing Address - Phone:702-762-1988
Mailing Address - Fax:
Practice Address - Street 1:VIRGIL HENSON ACTIVITIES CENTER, 2620 RUSSELL LONG BLVD
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015
Practice Address - Country:US
Practice Address - Phone:702-762-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1058051207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services