Provider Demographics
NPI:1679764948
Name:LEE, JOHN MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MATTHEW
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 1:6300 W PARKER RD STE 322
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8103
Mailing Address - Country:US
Mailing Address - Phone:972-981-7870
Mailing Address - Fax:972-981-7886
Practice Address - Street 1:6300 W PARKER RD STE 322
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8103
Practice Address - Country:US
Practice Address - Phone:972-981-7870
Practice Address - Fax:972-981-7886
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110985207RC0000X, 207R00000X
TXN3821207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX523108YKPWMedicare PIN
TX523108YKQLMedicare PIN
TX523108YKP5Medicare PIN