Provider Demographics
NPI:1174500144
Name:LEE, WILLIAM O (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:O
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 1:4 OAKTREE ST
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4073
Mailing Address - Country:US
Mailing Address - Phone:281-482-5551
Mailing Address - Fax:281-482-0995
Practice Address - Street 1:4 OAKTREE ST
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4073
Practice Address - Country:US
Practice Address - Phone:281-482-5551
Practice Address - Fax:281-482-0995
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BE110OtherBLUE CROSS BLUE SHIELD
TX8L1574Medicare PIN
TXI26646Medicare UPIN
TX8BE110OtherBLUE CROSS BLUE SHIELD