Provider Demographics
NPI:1992787055
Name:LEE, JAMES CARLTON (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CARLTON
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 1:519 N KING ST
Mailing Address - Street 2:STE 102
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-4866
Mailing Address - Country:US
Mailing Address - Phone:830-379-7901
Mailing Address - Fax:830-401-0737
Practice Address - Street 1:519 N KING ST
Practice Address - Street 2:STE 102
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-4866
Practice Address - Country:US
Practice Address - Phone:830-379-7901
Practice Address - Fax:830-401-0737
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8AJ804OtherBC/BS
TX8706N0Medicare PIN
TN8AJ804OtherBC/BS
TX00831RMedicare PIN