Provider Demographics
NPI:1235108697
Name:LEE, TYRONE (MD)
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:
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 1:3700 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7259
Mailing Address - Country:US
Mailing Address - Phone:501-327-9532
Mailing Address - Fax:501-327-9562
Practice Address - Street 1:3700 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7259
Practice Address - Country:US
Practice Address - Phone:501-327-9532
Practice Address - Fax:501-327-9562
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8126207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K067Medicare ID - Type Unspecified
ARG25773Medicare UPIN