Provider Demographics
NPI:1447229067
Name:LEE, THERESIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESIA
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:STE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-949-1888
Mailing Address - Fax:210-949-1540
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:STE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-949-1888
Practice Address - Fax:210-949-1540
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ0572207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D4056Medicare ID - Type Unspecified