MEDICARE: STACY L LEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD.206367	LA
2	2085R0202X	Diagnostic Radiology Physician	N2623	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BP1-0026377	OTHER		INSTITUTIONAL PERMIT

General Provider Information

NPI Number	:	1225232309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY L LEE MD

Provider Business Mailing Address
First Line	:	PO BOX 92038
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-0101
Country	:	US
Telephone Number	:	817-749-2001
Fax Number	:	940-483-1568

Provider Business Practice Location Address
First Line	:	300 MIRON DR
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-7862
Country	:	US
Telephone Number	:	817-749-2000
Fax Number	:	817-749-2020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	03/09/2026

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