Provider Demographics
NPI:1326455304
Name:ELIZABETH DEE, M.D., PLC
Entity Type:Organization
Organization Name:ELIZABETH DEE, M.D., PLC
Other - Org Name:CHILDREN'S DOCTORS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ONG
Authorized Official - Last Name:DEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-862-8377
Mailing Address - Street 1:264 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3336
Mailing Address - Country:US
Mailing Address - Phone:407-862-8377
Mailing Address - Fax:407-862-8883
Practice Address - Street 1:264 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3336
Practice Address - Country:US
Practice Address - Phone:407-862-8377
Practice Address - Fax:407-862-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 105201302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001535900Medicaid