Provider Demographics
NPI:1497073530
Name:LEE, JASON GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GLENN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 BRECKENRIDGE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-0839
Mailing Address - Country:US
Mailing Address - Phone:270-688-3550
Mailing Address - Fax:
Practice Address - Street 1:1000 BRECKENRIDGE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0839
Practice Address - Country:US
Practice Address - Phone:270-688-3550
Practice Address - Fax:270-688-3559
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYR2316208100000X
KY47256208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK157220Medicare PIN