Provider Demographics
NPI:1336334507
Name:LEE, JESSICA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
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 1:18220 TOMBALL PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:281-737-1320
Mailing Address - Fax:281-737-1321
Practice Address - Street 1:18220 TOMBALL PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-737-1320
Practice Address - Fax:281-737-1321
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7365207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1194OtherBLUE CROSS BLUE SHIELD OF TEXAS
TXP01142605OtherRR MEDICARE
TX189757102Medicaid
TX1336334507OtherBLUE CROSS BLUE SHIELD
TX189757104Medicaid
TXTXB119535Medicare PIN
TX189757104Medicaid