Healthcare Provider Details

I. General information

NPI: 1689675837
Provider Name (Legal Business Name): ALFRED LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16011 KAIROS RD STE 300
SOUTH CHESTERFIELD VA
23834-5207
US

IV. Provider business mailing address

107 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4521
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-5223
  • Fax:
Mailing address:
  • Phone: 804-330-4901
  • Fax: 804-330-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101033290
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: