Provider Demographics
NPI:1487739785
Name:LEE, EDWARD W (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
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 1:2020 NASA PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3683
Mailing Address - Country:US
Mailing Address - Phone:713-363-9090
Mailing Address - Fax:281-333-2490
Practice Address - Street 1:2020 NASA PKWY STE 230
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3683
Practice Address - Country:US
Practice Address - Phone:713-363-9090
Practice Address - Fax:281-333-2490
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229016207X00000X
AZ40622207X00000X
CA103377207X00000X
TXQ3037207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347470201Medicaid
AZ346127Medicaid
TXP01564679OtherRR MEDICARE
TX8EZ8880OtherBLUE CROSS BLUE SHIELD
TX404309YMVQMedicare PIN
TX347470201Medicaid