Provider Demographics
NPI:1083683106
Name:LEE, EDWIN N (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:N
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7009 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5123
Mailing Address - Country:US
Mailing Address - Phone:407-363-9665
Mailing Address - Fax:
Practice Address - Street 1:7009 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5123
Practice Address - Country:US
Practice Address - Phone:407-363-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75595207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL460002163OtherMEDICARE ID/RRM PIN
FL254502100Medicaid
FL43615Medicare PIN
FLG58693Medicare UPIN