Provider Demographics
NPI:1174631295
Name:LEE, JONG O (MD)
Entity Type:Individual
Prefix:
First Name:JONG
Middle Name:O
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:815 MARKET ST
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-2725
Mailing Address - Country:US
Mailing Address - Phone:409-770-6731
Mailing Address - Fax:409-770-6919
Practice Address - Street 1:815 MARKET ST
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-2725
Practice Address - Country:US
Practice Address - Phone:409-770-6731
Practice Address - Fax:409-770-6919
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL81072086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8718B7Medicaid
TX8718B7Medicaid