Provider Demographics
NPI:1952398299
Name:LEE, ALEX JOHN (DO)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:JOHN
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 1:27 MEDICAL GROUP
Mailing Address - Street 2:BLDG 1400 208 W CASABLANCA CANNON AFB
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88103-5014
Mailing Address - Country:US
Mailing Address - Phone:505-784-6608
Mailing Address - Fax:505-784-6028
Practice Address - Street 1:27 MEDICAL GROUP
Practice Address - Street 2:BLDG 1400 208 W CASABLANCA CANNON AFB
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88103-5014
Practice Address - Country:US
Practice Address - Phone:505-784-6608
Practice Address - Fax:505-784-6028
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002643A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN