Provider Demographics
NPI:1922147271
Name:LEE, NANCY A (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 374
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5615
Mailing Address - Country:US
Mailing Address - Phone:212-223-5483
Mailing Address - Fax:210-223-5492
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 374
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5615
Practice Address - Country:US
Practice Address - Phone:212-223-5483
Practice Address - Fax:210-223-5492
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0571207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA003OtherTRICARE
TXA003OtherTRICARE
TX8B7386Medicare ID - Type Unspecified