Healthcare Provider Details

I. General information

NPI: 1780855510
Provider Name (Legal Business Name): TRAVIS LEE FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 OLD GREENBRIER RD B
CHESAPEAKE VA
23320-2635
US

IV. Provider business mailing address

PO BOX 15763
CHESAPEAKE VA
23328-5763
US

V. Phone/Fax

Practice location:
  • Phone: 757-366-0200
  • Fax:
Mailing address:
  • Phone: 757-366-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101241301
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101241301
License Number StateVA

VIII. Authorized Official

Name: DR. TRAVIS LEE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 757-366-0200