Provider Demographics
NPI:1407039738
Name:LEE J FRIEND MD PA
Entity Type:Organization
Organization Name:LEE J FRIEND MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ASSOCIATE
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-554-5302
Mailing Address - Street 1:PO BOX 1759 DEPT. 952
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77251-1759
Mailing Address - Country:US
Mailing Address - Phone:713-554-5302
Mailing Address - Fax:713-554-5324
Practice Address - Street 1:1200 WALLACE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1741
Practice Address - Country:US
Practice Address - Phone:806-359-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018NGOtherBCBS
TXD48564OtherAETNA
TX177651001Medicaid
TX177651001Medicaid