Provider Demographics
NPI:1639179468
Name:LEE, SUSAN ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNETTE
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:124 E BANDERA RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2849
Mailing Address - Country:US
Mailing Address - Phone:830-816-2312
Mailing Address - Fax:830-816-2349
Practice Address - Street 1:124 E BANDERA RD
Practice Address - Street 2:STE. 102
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2849
Practice Address - Country:US
Practice Address - Phone:830-816-2312
Practice Address - Fax:830-816-2349
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2016-10-17
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Provider Licenses
StateLicense IDTaxonomies
TXG8897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86J373OtherWELLMED MEDICARE
TX3103152-01OtherWELLMED MEDICAID
TX86J373OtherWELLMED MEDICARE