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NPI Code Detail

MEDICARE: DR. BENJAMIN LYE M.D.

MEDICARE: DR. BENJAMIN LYE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianME36271FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115600OTHERFLBLUECROSSBLUESHIELDFL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3320538OTHERFLUNITEDBEHAVIORALHEALTH

General Provider Information

NPI Number : 1417035775
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN LYE M.D.
Provider Business Mailing Address
First Line : PO BOX 19189
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32245-9189
Country : US
Telephone Number : 904-743-1883
Fax Number : 904-743-5109
Provider Business Practice Location Address
First Line : 3333 W 20TH ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32254-1703
Country : US
Telephone Number : 904-695-9145
Fax Number : 904-695-2465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 05/29/2009

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