MEDICARE: S. DARRELL LEE,M.D., P.A

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	174400000X	Specialist	ME76643	FL

General Provider Information

NPI Number	:	1871757815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S. DARRELL LEE,M.D., P.A

Provider Business Mailing Address
First Line	:	8515 S US HIGHWAY 1
Second Line	:	SUITE 3
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-3346
Country	:	US
Telephone Number	:	772-878-8885
Fax Number	:	772-878-5898

Provider Business Practice Location Address
First Line	:	8515 S US HIGHWAY 1
Second Line	:	SUITE 3
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-3346
Country	:	US
Telephone Number	:	772-878-8885
Fax Number	:	772-878-5898

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SPENCER DARRELL LEE
Credential	:	M.D.
Telephone Number	:	772-878-8885

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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