MEDICARE: DR. WILLIAM SHANE LEE MD

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	207Q00000X	Family Medicine Physician	14282	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51551660	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1568550721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM SHANE LEE MD

Provider Business Mailing Address
First Line	:	HWY 45 SOUTH ROUTE 2
Second Line	:	BOX 4D
City	:	MARION
State	:	AL
Zip	:	36756
Country	:	US
Telephone Number	:	334-683-9085
Fax Number	:	334-683-9082

Provider Business Practice Location Address
First Line	:	HWY 45 SOUTH ROUTE 2
Second Line	:	MARION CLINIC
City	:	MARION
State	:	AL
Zip	:	36756
Country	:	US
Telephone Number	:	334-683-9085
Fax Number	:	334-683-9082

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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