Provider Demographics
NPI:1033376942
Name:LEE, JEANNE (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 MURCHISON DR STE 300
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2906
Mailing Address - Country:US
Mailing Address - Phone:915-401-8999
Mailing Address - Fax:915-774-2551
Practice Address - Street 1:1810 MURCHISON DR STE 300
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2906
Practice Address - Country:US
Practice Address - Phone:915-401-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200900043207R00000X, 208M00000X
TN46707207RH0002X, 208M00000X
CODR.0053410207RH0002X
NC135142390200000X
TXQ8542207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4300796OtherBCBST
TNP00968309OtherRR MEDICARE
TN01444793OtherAMERIGROUP
NC5911317Medicaid
KY7100169380Medicaid
TN1524170Medicaid
KY7100169380Medicaid
TN103I113565Medicare PIN