Healthcare Provider Details

I. General information

NPI: 1487732434
Provider Name (Legal Business Name): OLIVIA C LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SAINT CHARLES AVE 6TH FLOOR
NEW ORLEANS LA
70115-4637
US

IV. Provider business mailing address

1542 TULANE AVE BOX T6-7
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 504-412-1459
  • Fax: 504-412-1251
Mailing address:
  • Phone: 504-568-4680
  • Fax: 504-568-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number228507
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number260899
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberMD205423
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: