MEDICARE: MR. JONATHAN C LEE AP

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	171100000X	Acupuncturist	2809	FL

General Provider Information

NPI Number	:	1467716712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN C LEE AP

Provider Business Mailing Address
First Line	:	505 DELANNOY AVE
Second Line	:
City	:	COCOA
State	:	FL
Zip	:	32922-7813
Country	:	US
Telephone Number	:	321-454-9259
Fax Number	:	321-454-9974

Provider Business Practice Location Address
First Line	:	505 DELANNOY AVE
Second Line	:
City	:	COCOA
State	:	FL
Zip	:	32922-7813
Country	:	US
Telephone Number	:	321-454-9259
Fax Number	:	321-454-9974

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

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	02/24/2014

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Directions to “ MR. JONATHAN C LEE AP” Practice Location

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