=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588838528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEE V. ANSELL, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2008
-----------------------------------------------------
Last Update Date | 09/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5420 WEST LOOP S SUITE NO. 2400
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-314-4600
-----------------------------------------------------
Fax | 713-314-2990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5420 WEST LOOP S SUITE 2400
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-314-4600
-----------------------------------------------------
Fax | 713-314-2990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LEE V. ANSELL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-314-4600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | F1342
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------