Provider Demographics
NPI:1134128077
Name:LEE, JOSEPH RILLENS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RILLENS
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 1:423 PECAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-2514
Mailing Address - Country:US
Mailing Address - Phone:228-467-3449
Mailing Address - Fax:228-467-1975
Practice Address - Street 1:179 DRINKWATER RD
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1613
Practice Address - Country:US
Practice Address - Phone:228-467-0298
Practice Address - Fax:228-467-1975
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08095174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118499Medicaid
MS020000408Medicare ID - Type Unspecified
MS0118499Medicaid