Provider Demographics
NPI:1336345693
Name:LEE, GORDON A (RCS)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:A
Last Name:LEE
Suffix:
Gender:M
Credentials:RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-5009
Mailing Address - Country:US
Mailing Address - Phone:318-219-7964
Mailing Address - Fax:
Practice Address - Street 1:451 ELMWOOD ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-5009
Practice Address - Country:US
Practice Address - Phone:318-219-7964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography