Provider Demographics
NPI:1306959051
Name:LEE, SEREI Y (DPM)
Entity type:Individual
Prefix:DR
First Name:SEREI
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:SEREI
Other - Middle Name:C
Other - Last Name:Y
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:713 N WARE RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6616
Mailing Address - Country:US
Mailing Address - Phone:956-682-8496
Mailing Address - Fax:956-682-0590
Practice Address - Street 1:713 N WARE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6616
Practice Address - Country:US
Practice Address - Phone:956-682-8496
Practice Address - Fax:956-682-0590
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1817213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191847601Medicaid
509131YMVUOtherWNI
V10420Medicare UPIN
TX613125Medicare PIN
509131YMVUOtherWNI