Provider Demographics
NPI:1871757815
Name:S. DARRELL LEE,M.D., P.A
Entity type:Organization
Organization Name:S. DARRELL LEE,M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-878-8885
Mailing Address - Street 1:8515 S US HIGHWAY 1
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3346
Mailing Address - Country:US
Mailing Address - Phone:772-878-8885
Mailing Address - Fax:772-878-5898
Practice Address - Street 1:8515 S US HIGHWAY 1
Practice Address - Street 2:SUITE 3
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3346
Practice Address - Country:US
Practice Address - Phone:772-878-8885
Practice Address - Fax:772-878-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76643174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG36268Medicare UPIN
FL44220Medicare PIN