Provider Demographics
NPI:1295911287
Name:LEE, BRIAN SPENCER (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:SPENCER
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 DELIVERY LANE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2292
Mailing Address - Country:US
Mailing Address - Phone:580-924-5622
Mailing Address - Fax:580-745-5060
Practice Address - Street 1:1708 DELIVERY LANE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2292
Practice Address - Country:US
Practice Address - Phone:580-924-5622
Practice Address - Fax:580-745-5060
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3864111NX0800X
OK5586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No111NX0800XChiropractic ProvidersChiropractorOrthopedic