Provider Demographics
NPI:1659316370
Name:DEE, MANUEL G (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:G
Last Name:DEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 CENTURY MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2142
Mailing Address - Country:US
Mailing Address - Phone:321-269-9660
Mailing Address - Fax:321-269-2632
Practice Address - Street 1:835 CENTURY MEDICAL DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2142
Practice Address - Country:US
Practice Address - Phone:321-269-9660
Practice Address - Fax:321-269-2632
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0029226207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79017Medicare ID - Type Unspecified
FLD86317Medicare UPIN