Healthcare Provider Details

I. General information

NPI: 1114458023
Provider Name (Legal Business Name): DAVID L LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 S BRENTWOOD BLVD STE 1120
SAINT LOUIS MO
63117-1211
US

IV. Provider business mailing address

1008 S SPRING AVE FL 3
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-4600
  • Fax: 618-726-1653
Mailing address:
  • Phone: 314-977-8480
  • Fax: 314-977-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2022037025
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: