MEDICARE: DR. DONG ALEXANDER LEE MD

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
1	207P00000X	Emergency Medicine Physician	ME0078771	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62741	OTHER	FL	BCBS
2	P00414211	OTHER		RR MCR

General Provider Information

NPI Number	:	1437177029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONG ALEXANDER LEE MD

Provider Business Mailing Address
First Line	:	2420 NE 33RD ST
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-8143
Country	:	US
Telephone Number	:	954-786-7122
Fax Number	:	954-786-7158

Provider Business Practice Location Address
First Line	:	2420 NE 33RD ST
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-8143
Country	:	US
Telephone Number	:	954-786-7122
Fax Number	:	954-786-7158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	12/19/2007

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