Provider Demographics
NPI:1639498462
Name:LEE, VINCENT G (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:G
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3501 CARRIAGE HILL DR STE B
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5329
Mailing Address - Country:US
Mailing Address - Phone:870-573-2200
Mailing Address - Fax:870-573-2300
Practice Address - Street 1:3501 CARRIAGE HILL DR STE B
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5329
Practice Address - Country:US
Practice Address - Phone:870-573-2200
Practice Address - Fax:870-573-2300
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE7533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR198030001Medicaid
AR198030001Medicaid