Provider Demographics
NPI:1861837668
Name:LEE, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
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 1:6140 PRECINCT LINE RD # 200
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2610
Mailing Address - Country:US
Mailing Address - Phone:817-847-7760
Mailing Address - Fax:817-847-7764
Practice Address - Street 1:6140 PRECINCT LINE RD # 200
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2610
Practice Address - Country:US
Practice Address - Phone:817-847-7760
Practice Address - Fax:817-847-7764
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4085207Q00000X, 207Q00000X
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program