Provider Demographics
NPI:1770569949
Name:LEE, THOMAS W (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 JELLICORSE RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1836
Mailing Address - Country:US
Mailing Address - Phone:423-581-4881
Mailing Address - Fax:423-581-8266
Practice Address - Street 1:1964 JELLICORSE RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-1836
Practice Address - Country:US
Practice Address - Phone:423-581-4881
Practice Address - Fax:423-581-8266
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28187207L00000X
TNMD20534207L00000X
KY36353207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3052080Medicare ID - Type Unspecified
C85106Medicare UPIN