Provider Demographics
NPI:1386803633
Name:LEE, JULIAN (MD)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:
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 1:763 E US HIGHWAY 80 STE 100
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8675
Mailing Address - Country:US
Mailing Address - Phone:972-564-0711
Mailing Address - Fax:972-564-0323
Practice Address - Street 1:763 E US HIGHWAY 80 STE 100
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8675
Practice Address - Country:US
Practice Address - Phone:972-564-0711
Practice Address - Fax:972-564-0323
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN6910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB163437Medicare PIN
TXTXB163438Medicare PIN
TXTXB163439Medicare PIN