Provider Demographics
NPI:1194736439
Name:LEE, LISA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
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:PO BOX 2164
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70059-2164
Mailing Address - Country:US
Mailing Address - Phone:504-975-9909
Mailing Address - Fax:504-366-4038
Practice Address - Street 1:2000 BRADFORD PL
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-1419
Practice Address - Country:US
Practice Address - Phone:504-975-9909
Practice Address - Fax:504-366-4038
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1979031Medicaid
LA5U035Medicare ID - Type Unspecified
LA1979031Medicaid