Individual
DR. LEE LYLE WARDLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1264 WESLEY DRIVE, #602, MEMPHIS, TN 38116-6459
(901) 396-0311
(901) 516-3869
Mailing address
1264 WESLEY DRIVE, #602, MEMPHIS, TN 38116-6459
(901) 396-0311
(901) 516-3869
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
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