Provider Demographics
NPI:1629098348
Name:LEE, LAWRENCE E (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:LEE
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 1:601 EAST 14TH STREET
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65302-1706
Mailing Address - Country:US
Mailing Address - Phone:660-827-9199
Mailing Address - Fax:660-826-0171
Practice Address - Street 1:601 EAST 14TH STREET
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65302-1706
Practice Address - Country:US
Practice Address - Phone:660-827-9199
Practice Address - Fax:660-826-0171
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR46462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00604390OtherRR MEDICARE
MO201018512Medicaid
MO02622031OtherBCBS
MO367000001Medicare PIN