Provider Demographics
NPI:1962656728
Name:SEREI Y. LEE, DPM PA
Entity Type:Organization
Organization Name:SEREI Y. LEE, DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEREI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:361-883-5955
Mailing Address - Street 1:2727 MORGAN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1825
Mailing Address - Country:US
Mailing Address - Phone:361-883-5955
Mailing Address - Fax:361-882-3365
Practice Address - Street 1:2727 MORGAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1825
Practice Address - Country:US
Practice Address - Phone:361-883-5955
Practice Address - Fax:361-882-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1817213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6176260001OtherDMERC
TX6176260001OtherDMERC
TX6176260001Medicare NSC