Provider Demographics
NPI:1568575231
Name:ANSELL, LEE VAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:VAN
Last Name:ANSELL
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 1:5420 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2103
Mailing Address - Country:US
Mailing Address - Phone:713-314-4600
Mailing Address - Fax:713-314-2900
Practice Address - Street 1:5420 WEST LOOP SOUTH
Practice Address - Street 2:SUITE 2400
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2103
Practice Address - Country:US
Practice Address - Phone:713-314-4600
Practice Address - Fax:713-314-2990
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1342174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE18140Medicare UPIN
TX0074AXMedicare ID - Type Unspecified