Provider Demographics
NPI:1265490296
Name:LEE, KARLA (MD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
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 1:1600 W COLLEGE ST
Mailing Address - Street 2:#130
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3580
Mailing Address - Country:US
Mailing Address - Phone:817-310-3600
Mailing Address - Fax:817-310-3800
Practice Address - Street 1:1500 BEVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5644
Practice Address - Country:US
Practice Address - Phone:386-238-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3339207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060070668OtherMEDICARE RAILROAD
TX8AW323OtherBCBS-INDIVIDUAL
TXG55246Medicare UPIN