| Doctor Name: | JERRY K LEE |
| NPI Number: | 1184809030 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 01010575543 |
| Business Practice Address: | 7524 Diplomat Dr Manassas, VA - 201092685 |
| Business Phone Number: | 7033614357 |
| Business Fax Number: | 7033610346 |
| Mailing Address: | Po Box 2041, MANASSAS |
| State: | VA |
| Postal Code: | 201080815 |
| Phone Number: | 7033614357 |
| Fax Number: | 7033610346 |
| NPI Enumeration Date: | 01/09/2008 |
| NPI Last Update Date: | 01/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 01010575543 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |