Provider Demographics
NPI:1659312700
Name:LEE, W ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:ANTHONY
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WOONGCHAE
Other - Middle Name:ANTHONY
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1001 NW 13TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2269
Mailing Address - Country:US
Mailing Address - Phone:561-955-6663
Mailing Address - Fax:561-955-2879
Practice Address - Street 1:670 GLADES RD STE 100
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6462
Practice Address - Country:US
Practice Address - Phone:561-955-3500
Practice Address - Fax:561-955-2690
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME834192086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259045000Medicaid
FL35586Medicare ID - Type Unspecified
FL259045000Medicaid
FL35586ZMedicare PIN