Provider Demographics
NPI:1982811618
Name:LEE, ROY MALCOLM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:MALCOLM
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROY
Other - Middle Name:MALCOLM
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12660 HUMPHREYS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-7920
Mailing Address - Country:US
Mailing Address - Phone:225-754-7692
Mailing Address - Fax:
Practice Address - Street 1:12660 HUMPHREYS DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-7920
Practice Address - Country:US
Practice Address - Phone:225-754-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016346209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes209800000XAllopathic & Osteopathic PhysiciansLegal Medicine