Individual
DR. LEE LYLE WARDLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
05332
MS
207RG0100X
Gastroenterology Physician
Primary
MD008559
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00014795
—
MS
01
—
1000000014
MEDIARE
MS
Enumeration date
10/18/2006
Last updated
07/08/2007
Update your record
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