Individual
THEODORE MARK LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
024014
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00278649H
—
GA
01
—
00278649K
MEDICADE
GA
01
—
0481981
AETNA
—
01
—
1950
COVENTRY
—
01
—
2754388008
CIGNA
—
01
—
480827
BCBS
—
01
—
8791
KAISER POS
—
01
—
P00162933
RAILROAD MEDICARE
GA
Enumeration date
07/07/2006
Last updated
04/06/2012
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