Provider Demographics
NPI:1275558900
Name:LEE, THEODORE T (MD,)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:T
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 1:7975 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8202
Mailing Address - Country:US
Mailing Address - Phone:407-303-8683
Mailing Address - Fax:407-303-6839
Practice Address - Street 1:7975 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8202
Practice Address - Country:US
Practice Address - Phone:407-303-8683
Practice Address - Fax:407-303-6839
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 80822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262656000Medicaid
FLH25637Medicare UPIN
FL51786ZMedicare ID - Type Unspecified