Provider Demographics
NPI:1053614636
Name:LEE, NICOLINE VIOLET (MD)
Entity type:Individual
Prefix:
First Name:NICOLINE
Middle Name:VIOLET
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18220 STATE HIGHWAY 249
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:281-737-0570
Mailing Address - Fax:281-807-6024
Practice Address - Street 1:18220 STATE HIGHWAY 249
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-737-0570
Practice Address - Fax:281-807-6024
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2016-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN7939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1053614636OtherBLUE CROSS BLUE SHIELD
TX8DT625OtherBLUE CROSS BLUE SHIELD
TX286020702Medicaid
TX286020701Medicaid
TX8CX801OtherBLUE CROSS BLUE SHIELD
TXP01152529OtherRR MEDICARE
TXP01312375OtherRR MEDICARE
TX293546ZSWDMedicare PIN
TX8CX801OtherBLUE CROSS BLUE SHIELD
TX293546YMVQMedicare PIN