Provider Demographics
NPI:1275559106
Name:LEE, NOAH (DO)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1421 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4434
Mailing Address - Country:US
Mailing Address - Phone:954-565-0875
Mailing Address - Fax:954-565-0876
Practice Address - Street 1:1421 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4434
Practice Address - Country:US
Practice Address - Phone:954-565-0875
Practice Address - Fax:954-565-0876
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS9305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59005OtherBCBS
FL305302OtherAVMED
FL7226862OtherAETNA
FLS093051OtherPREFERRED
FL19148OtherEVOLUTIONS
7994899OtherCIGNA
FL138015OtherGHI
FL278849700Medicaid
FL278849700Medicaid