Healthcare Provider Details

I. General information

NPI: 1356334866
Provider Name (Legal Business Name): CHRISTOPHER COLLINS LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13828 COURSEY BLVD
BATON ROUGE LA
70817
US

IV. Provider business mailing address

13828 COURSEY BLVD
BATON ROUGE LA
70817
US

V. Phone/Fax

Practice location:
  • Phone: 225-752-4530
  • Fax: 225-752-4652
Mailing address:
  • Phone: 225-752-4530
  • Fax: 225-752-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number025495
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: