Provider Demographics
NPI:1396888194
Name:LEE, JANE J (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:J
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 1:411 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:214-370-5700
Mailing Address - Fax:214-358-4324
Practice Address - Street 1:411 N WASHINGTON AVE
Practice Address - Street 2:SUITE 2400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-370-5700
Practice Address - Fax:214-358-4324
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1367207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A3585Medicare ID - Type Unspecified
H50421Medicare UPIN