Provider Demographics
NPI:1427858661
Name:LEE, JEFFREY TAYLOR
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:TAYLOR
Last Name:LEE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 HEYD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4327
Mailing Address - Country:US
Mailing Address - Phone:337-513-5471
Mailing Address - Fax:
Practice Address - Street 1:1619 SAMPSON ST STE B
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:LA
Practice Address - Zip Code:70669-4013
Practice Address - Country:US
Practice Address - Phone:337-202-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program