Provider Demographics
NPI:1316966971
Name:LEE, ALBERT C (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:C
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:520 E DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8307
Practice Address - Country:US
Practice Address - Phone:903-593-1721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58417174400000X
TXN09162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196640002Medicaid
TX8CU212OtherBCBS JV LOCATION
TX196640001Medicaid
TX196640003Medicaid
TXTIN PLUS 113OtherTRICARE
TX196640004Medicaid
TXTIN PLUS 013OtherTRICARE
TX8BC077OtherBCBS OF TEXAS
TX8AP484OtherBCBS
TXTIN PLUS 005OtherTRICARE JV LOCATION
TXTIN PLUS 007OtherTRICARE
TX8L2480Medicare Oscar/Certification
TX8BC077OtherBCBS OF TEXAS
TX196640004Medicaid
TX196640002Medicaid
TX8L1782Medicare Oscar/Certification
TXTIN PLUS 007OtherTRICARE
TX8CU212OtherBCBS JV LOCATION