MEDICARE: WAYNE LEE MD PLASTIC SURGERY PLLC

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	2086S0122X	Plastic and Reconstructive Surgery Physician	ME93895	FL

General Provider Information

NPI Number	:	1710269097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE LEE MD PLASTIC SURGERY PLLC

Provider Business Mailing Address
First Line	:	1971 W LUMSDEN RD STE 350
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-8820
Country	:	US
Telephone Number	:	813-579-3369
Fax Number	:	866-202-3227

Provider Business Practice Location Address
First Line	:	1020 E BRANDON BLVD STE 101
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5560
Country	:	US
Telephone Number	:	813-579-3369
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WAYNE C LEE
Credential	:	MD
Telephone Number	:	813-579-3369

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	01/02/2020

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