Provider Demographics
NPI:1023004413
Name:LEE, JUSTIN T (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:T
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 1:5001 S COOPER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5993
Mailing Address - Country:US
Mailing Address - Phone:866-367-8768
Mailing Address - Fax:817-541-9555
Practice Address - Street 1:5005 S COOPER ST STE 250
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5996
Practice Address - Country:US
Practice Address - Phone:866-367-8768
Practice Address - Fax:817-541-9540
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3726208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150756804OtherMEDICAID OTHER
TX150756801Medicaid
TX150756802Medicaid
TX150756803Medicaid
TX150756805Medicaid
TXH56850Medicare UPIN
TX150756802Medicaid
TX150756803Medicaid
TXTXB102127Medicare PIN