Provider Demographics
NPI:1255367108
Name:LEE, JOHN Y (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:Y
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:PO BOX 311627
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-1627
Mailing Address - Country:US
Mailing Address - Phone:830-625-0305
Mailing Address - Fax:830-625-2693
Practice Address - Street 1:774 LANDA ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6114
Practice Address - Country:US
Practice Address - Phone:830-625-0305
Practice Address - Fax:830-625-2693
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042190101Medicaid
TX126961501OtherGROUP MEDICAID
TX00R38TOtherGROUP MEDICARE
1952326993OtherGROUP NPI
TX00R38TOtherGROUP MEDICARE
TX042190101Medicaid