Provider Demographics
NPI:1467694653
Name:LEE, VIRGIL ALLEN (HIS)
Entity Type:Individual
Prefix:MR
First Name:VIRGIL
Middle Name:ALLEN
Last Name:LEE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9023 OXFORD CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77864-6055
Mailing Address - Country:US
Mailing Address - Phone:979-324-7057
Mailing Address - Fax:936-348-2298
Practice Address - Street 1:9023 OXFORD CEMETERY RD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TX
Practice Address - Zip Code:77864-6055
Practice Address - Country:US
Practice Address - Phone:979-324-7057
Practice Address - Fax:936-348-2298
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80298237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter