Healthcare Provider Details

I. General information

NPI: 1629040647
Provider Name (Legal Business Name): LEE MONROE DENNIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 FOREST ST
DOVER DE
19904-3470
US

IV. Provider business mailing address

960 FOREST ST
DOVER DE
19904-3470
US

V. Phone/Fax

Practice location:
  • Phone: 302-735-1888
  • Fax: 302-735-1802
Mailing address:
  • Phone: 302-735-1888
  • Fax: 302-735-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC1-0002705
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: