Healthcare Provider Details

I. General information

NPI: 1184607269
Provider Name (Legal Business Name): ELIZABETH DEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-3336
US

IV. Provider business mailing address

264 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-3336
US

V. Phone/Fax

Practice location:
  • Phone: 407-862-8311
  • Fax: 407-862-8883
Mailing address:
  • Phone: 407-862-8377
  • Fax: 407-862-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036090305
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME105201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: