Provider Demographics
NPI:1619036993
Name:LEE, CONSTANCE W (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:W
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8235
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-6070
Mailing Address - Fax:314-454-2442
Practice Address - Street 1:1 CHILDRENS PL STE A
Practice Address - Street 2:STE A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6070
Practice Address - Fax:314-454-2442
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016013269208600000X
ORMD2159432086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO161903699Medicaid
ILENROLLEDMedicaid