Provider Demographics
NPI:1386192458
Name:LEEJAY, ARVY WAYNE II
Entity Type:Individual
Prefix:
First Name:ARVY
Middle Name:WAYNE
Last Name:LEEJAY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 TIOGA ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-6229
Mailing Address - Country:US
Mailing Address - Phone:214-335-9498
Mailing Address - Fax:
Practice Address - Street 1:4229 TIOGA ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-6229
Practice Address - Country:US
Practice Address - Phone:214-335-9498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32060794768171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor