Provider Demographics
NPI:1508879909
Name:PO W. LEE,M.D.,P.A.
Entity Type:Organization
Organization Name:PO W. LEE,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PO
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-641-2468
Mailing Address - Street 1:8951 RUTHBY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77061-3140
Mailing Address - Country:US
Mailing Address - Phone:713-641-2468
Mailing Address - Fax:
Practice Address - Street 1:8951 RUTHBY ST STE 1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-3140
Practice Address - Country:US
Practice Address - Phone:713-641-2468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1017261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0996795-02Medicaid
TXC18271Medicare UPIN
TX0996795-02Medicaid