Provider Demographics
NPI:1861669400
Name:LEE, STANTON (MD)
Entity Type:Individual
Prefix:
First Name:STANTON
Middle Name:
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 1:3436 MAGAZINE ST
Mailing Address - Street 2:# 310
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2413
Mailing Address - Country:US
Mailing Address - Phone:504-264-2515
Mailing Address - Fax:
Practice Address - Street 1:3436 MAGAZINE ST
Practice Address - Street 2:# 310
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2413
Practice Address - Country:US
Practice Address - Phone:504-264-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA40492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program