Healthcare Provider Details

I. General information

NPI: 1497175236
Provider Name (Legal Business Name): PAUL NICHOLAS LEE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2014
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 2003B
BATON ROUGE LA
70808-4300
US

IV. Provider business mailing address

3401 GRENADIER CT
MOBILE AL
36695
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-0952
  • Fax:
Mailing address:
  • Phone: 251-709-4759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number308867
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number308867
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: