Provider Demographics
NPI:1619130895
Name:LEE, KATE (MD)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
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 1:11442 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6602
Mailing Address - Country:US
Mailing Address - Phone:214-754-0000
Mailing Address - Fax:
Practice Address - Street 1:18661 LBJ FWY STE 400
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6468
Practice Address - Country:US
Practice Address - Phone:214-754-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203220207W00000X
TXP4337207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB165632Medicare PIN