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General NPI Number Information
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NPI Number | 1871757815
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Entity Type | Organization
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Legal Business Name | S. DARRELL LEE,M.D., P.A
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 8515 S US HIGHWAY 1 SUITE 3
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-3346
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Country | US
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Telephone | 772-878-8885
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Fax | 772-878-5898
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Provider Business Mailing Address
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Address Line | 8515 S US HIGHWAY 1 SUITE 3
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-3346
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Country | US
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Telephone | 772-878-8885
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Fax | 772-878-5898
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SPENCER DARRELL LEE
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Credential | M.D.
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Telephone | 772-878-8885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME76643
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License Number State | FL
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