Provider Demographics
NPI:1518968437
Name:PANKEY, LEE R (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:R
Last Name:PANKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5303
Mailing Address - Country:US
Mailing Address - Phone:318-323-1834
Mailing Address - Fax:318-323-0376
Practice Address - Street 1:109 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5303
Practice Address - Country:US
Practice Address - Phone:318-323-1834
Practice Address - Fax:318-323-0376
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013263207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1331473Medicaid
LA$$$$$$$$$AOtherBLUE CROSS OF LA
LA$$$$$$$$$OtherTRICARE
LA$$$$$$$$$AOtherBLUE CROSS OF LA
LA1331473Medicaid
LAB65347Medicare UPIN