Individual
DR. KERRY TODD LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1300 SUNSET DR, SUITE F, GRENADA, MS 38901-4086
(662) 226-5747
(662) 226-5622
Mailing address
1300 SUNSET DR, SUITE F, GRENADA, MS 38901-4086
(662) 226-5747
(662) 226-5622
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12517
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112670
—
MS
01
—
080175512
RAILROAD MEDICARE
MS
05
—
09013778
—
MS
05
—
09014826
—
MS
01
—
1700994738
PECOS
MS
01
—
640835695
BC/BS OF MISSISSIPPI
MS
01
—
CH9466
RAILROAD MEDICARE GROUP
MS
Enumeration date
07/17/2006
Last updated
06/28/2010
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