Provider Demographics
NPI:1366537482
Name:LEE, ROBERT LOUIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LOUIS
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 1:805 HILL BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1482
Mailing Address - Country:US
Mailing Address - Phone:817-573-3447
Mailing Address - Fax:817-573-3616
Practice Address - Street 1:805 HILL BLVD
Practice Address - Street 2:STE 103
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1482
Practice Address - Country:US
Practice Address - Phone:817-573-3447
Practice Address - Fax:817-573-3616
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXKO511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145044701Medicaid
TX8883M0Medicare PIN
TXG32569Medicare UPIN