Provider Demographics
NPI:1194779041
Name:LEE, THOMAS K (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12152 TESSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1726
Mailing Address - Country:US
Mailing Address - Phone:314-849-5414
Mailing Address - Fax:314-849-2042
Practice Address - Street 1:12152 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1726
Practice Address - Country:US
Practice Address - Phone:314-849-5414
Practice Address - Fax:314-849-2042
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO103081207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0900148OtherUNITED HEALTHCARE
MO18086OtherBLUE CROSS BLUE SHIELD
MO007011602OtherMEDICARE
MO200034223OtherMEDICARE RAILROAD
MO339445OtherGROUP HEALTH PLAN
MO4330231OtherAETNA
MO225019OtherHEALTHLINK
MO225019OtherHEALTHLINK
MO200034223OtherMEDICARE RAILROAD