MEDICARE: DR. DAVID LEE FACTOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	9601304	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	612648700	OTHER	US DOL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518940147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LEE FACTOR M.D.

Provider Business Mailing Address
First Line	:	734 N 3RD ST STE 115
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-5287
Country	:	US
Telephone Number	:	352-365-2583
Fax Number	:	352-728-6749

Provider Business Practice Location Address
First Line	:	801 E DIXIE AVE STE 104
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-7601
Country	:	US
Telephone Number	:	352-787-5858
Fax Number	:	352-787-4655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	11/13/2019

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Directions to “ DR. DAVID LEE FACTOR M.D.” Practice Location

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