Individual
DR. BRANDON DAVID LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
135 W RAVINE RD, SUITE 2C, KINGSPORT, TN 37660-3847
(423) 246-7372
(423) 578-4369
Mailing address
135 W RAVINE RD, SUITE 2C, KINGSPORT, TN 37660-3847
(423) 246-7372
(423) 578-4369
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
22313
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103I181026
MEDICARE PTAN
TN
Enumeration date
05/17/2006
Last updated
02/06/2012
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