Provider Demographics
NPI:1568762086
Name:LEE, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1545 HAND AVE
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1139
Mailing Address - Country:US
Mailing Address - Phone:386-673-3939
Mailing Address - Fax:386-677-5374
Practice Address - Street 1:1545 HAND AVE
Practice Address - Street 2:SUITE B-3
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1139
Practice Address - Country:US
Practice Address - Phone:386-673-3939
Practice Address - Fax:386-677-5374
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME108454207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology