Healthcare Provider Details

I. General information

NPI: 1902810112
Provider Name (Legal Business Name): RICHARD W LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 LONE OAK RD STE 405
PADUCAH KY
42003-7942
US

IV. Provider business mailing address

1532 LONE OAK RD STE 405
PADUCAH KY
42003-7942
US

V. Phone/Fax

Practice location:
  • Phone: 270-441-4300
  • Fax: 270-441-4370
Mailing address:
  • Phone: 270-441-4300
  • Fax: 270-441-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number62077
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberN6465
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberN6465
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: