Provider Demographics
NPI:1962403105
Name:LEE, ANDREW G (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:G
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-8843
Mailing Address - Fax:713-441-6463
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 450
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-441-8843
Practice Address - Fax:713-441-6463
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA33357207W00000X
TXJ7048207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00782064OtherMEDICARE RAILROAD
TXP01063017OtherRAILROAD MEDICARE
TX125175306Medicaid
IA16243OtherWELLMARK BCBS
TX8BZ089OtherBLUE CROSS BLUE SHIELD
TX125175305Medicaid
IA0206417Medicaid
TX8DZ190OtherBLUE CROSS BLUE SHIELD
TX8L10542Medicare PIN
TXP00782064OtherMEDICARE RAILROAD
F64335Medicare UPIN
TX125175306Medicaid
TX8BZ089OtherBLUE CROSS BLUE SHIELD