Provider Demographics
NPI:1396740353
Name:LEE, JOHN HENRY (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
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 1:4886 DOWLEN RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-4828
Mailing Address - Country:US
Mailing Address - Phone:409-273-7235
Mailing Address - Fax:833-749-0336
Practice Address - Street 1:4886 DOWLEN RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-4828
Practice Address - Country:US
Practice Address - Phone:409-273-7235
Practice Address - Fax:833-749-0336
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-12-27
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
TXH2527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122432101Medicaid
TXD79598Medicare UPIN
TX122432101Medicaid