Provider Demographics
NPI:1497781298
Name:LEE, KENT ALAN (MA MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:ALAN
Last Name:LEE
Suffix:
Gender:M
Credentials:MA MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-226-3610
Practice Address - Fax:901-226-3612
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN27084207Q00000X
TN027084208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine