Individual
JOHN MARTIN LEE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1542 MEDICAL PARK CIR, TUPELO, MS 38801-6560
(662) 844-4711
(662) 844-9619
Mailing address
1542 MEDICAL PARK CIR, TUPELO, MS 38801-6560
(662) 844-4711
(662) 844-9619
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
10710
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00010520
—
MS
05
—
009002820
—
AL
01
—
0114538
BLUE CROSS BLUE SHIELD MS
MS
01
—
10710
STATE LIC NUMBER
MS
01
—
73012088
BLUE CROSS BLUE SHIELD/ OTHER STATES
—
Enumeration date
01/24/2006
Last updated
06/30/2008
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