Provider Demographics
NPI:1497898027
Name:LEE, MERCER III (MD)
Entity Type:Individual
Prefix:DR
First Name:MERCER
Middle Name:
Last Name:LEE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PERCY
Other - Middle Name:MERCER
Other - Last Name:LEE
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:291 E LAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9527
Mailing Address - Country:US
Mailing Address - Phone:601-936-9190
Mailing Address - Fax:601-932-6714
Practice Address - Street 1:291 E LAYFAIR DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9527
Practice Address - Country:US
Practice Address - Phone:601-936-9190
Practice Address - Fax:601-932-6714
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07026207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018444Medicaid
MS160000134Medicare ID - Type Unspecified
MS00018444Medicaid