Provider Demographics
NPI:1780475053
Name:LEE, COREY TYRONE (BS MT)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:TYRONE
Last Name:LEE
Suffix:
Gender:M
Credentials:BS MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 S RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-4600
Mailing Address - Country:US
Mailing Address - Phone:901-870-5956
Mailing Address - Fax:
Practice Address - Street 1:ROCKY BOY HEALTH CENTER
Practice Address - Street 2:6850 UPPER BOX ELDER ROAD
Practice Address - City:BOX ELDER
Practice Address - State:MT
Practice Address - Zip Code:59521
Practice Address - Country:US
Practice Address - Phone:406-395-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18454246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist