Provider Demographics
NPI:1629039573
Name:LEE, SUSAN T (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:9798 BELLAIRE BLVD
Mailing Address - Street 2:#D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3427
Mailing Address - Country:US
Mailing Address - Phone:713-270-7224
Mailing Address - Fax:713-270-0084
Practice Address - Street 1:9798 BELLAIRE BLVD
Practice Address - Street 2:#D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3427
Practice Address - Country:US
Practice Address - Phone:713-270-7224
Practice Address - Fax:713-270-0084
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK3300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040777701Medicaid
TX8270M1Medicare PIN