Provider Demographics
NPI:1558402495
Name:A. LEE GUINN, JR., MD PA
Entity Type:Organization
Organization Name:A. LEE GUINN, JR., MD PA
Other - Org Name:LONGEVITY & WELLNESS CENTER OF SOUTH TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GUINN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:361-225-0800
Mailing Address - Street 1:1329 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3333
Mailing Address - Country:US
Mailing Address - Phone:361-727-9768
Mailing Address - Fax:361-727-9783
Practice Address - Street 1:1329 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-3333
Practice Address - Country:US
Practice Address - Phone:361-727-9768
Practice Address - Fax:361-727-9783
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A. LEE GUINN, JR., MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8529207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008259NOtherBLUE CROSS BLUE SHIELD
TX00829NMedicare PIN