Individual
MR. MARK KEITH LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 LANTANA ROAD, SUITE 202, CROSSVILLE, TN 38555-1903
(931) 484-5141
(931) 484-5620
Mailing address
100 LANTANA ROAD, SUITE 202, CROSSVILLE, TN 38555-1903
(931) 484-5141
(931) 484-5620
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD17713
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139003
BLUE CROSS
TN
05
—
3067149
—
TN
Enumeration date
08/10/2006
Last updated
06/29/2020
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