Provider Demographics
NPI:1598833543
Name:LEE, WAYNE C (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1971 W LUMSDEN RD STE 350
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8820
Mailing Address - Country:US
Mailing Address - Phone:813-579-3369
Mailing Address - Fax:866-202-3227
Practice Address - Street 1:1020 E BRANDON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-579-3369
Practice Address - Fax:866-202-3227
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL93895208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1598833543OtherNPI
IN067770BOtherMEDICARE