MEDICARE: DR. WAYNE C 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	208200000X	Plastic Surgery Physician	93895	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	067770B	OTHER	IN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1598833543	OTHER	IN	NPI

General Provider Information

NPI Number	:	1598833543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE C LEE MD

Provider Business Mailing Address
First Line	:	1971 W LUMSDEN RD STE 350
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-8820
Country	:	US
Telephone Number	:	813-579-3369
Fax Number	:	866-202-3227

Provider Business Practice Location Address
First Line	:	1020 E BRANDON BLVD STE 101
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511
Country	:	US
Telephone Number	:	813-579-3369
Fax Number	:	866-202-3227

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	12/20/2020

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