Provider Demographics
NPI:1700884533
Name:LEE, THOMAS M (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633146367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172611905Medicaid
TX85022UOtherBLUE CROSS BLUE SHIELD
TX172611910Medicaid
TX172611906Medicaid
TX172611916Medicaid
TX172611907Medicaid
TX172611901Medicaid
TX172611908Medicaid
TX172611909Medicaid
TX8343UGOtherBCBS TX
TX87028UOtherBCBS
TXP00956814OtherRAILROAD
TX172611905Medicaid
TXTXB106376Medicare PIN
8D3405Medicare PIN
TX172611916Medicaid
TX85022UOtherBLUE CROSS BLUE SHIELD
TX172611906Medicaid
TX172611901Medicaid
TX8K0493Medicare PIN
TXTXB107539Medicare PIN