Provider Demographics
NPI:1285629733
Name:JANSON, LEE WILLIAM (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:WILLIAM
Last Name:JANSON
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4/9 ADVOCATES CLOSE
Mailing Address - Street 2:357 HIGH STREET
Mailing Address - City:EDINBURGH
Mailing Address - State:SCOTLAND
Mailing Address - Zip Code:EH1 1PS
Mailing Address - Country:GB
Mailing Address - Phone:44131-225-2117
Mailing Address - Fax:
Practice Address - Street 1:4/9 ADVOCATES CLOSE
Practice Address - Street 2:357 HIGH STREET
Practice Address - City:EDINBURGH
Practice Address - State:SCOTLAND
Practice Address - Zip Code:EH1 1PS
Practice Address - Country:GB
Practice Address - Phone:44131-225-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL4006OtherTEXAS STATEBOARD OF MEDICAL EXAMINERS (TEXAS MEDICAL LICENSE)