Provider Demographics
NPI:1689663866
Name:BOXBERGER, LEE ALLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ALLEN
Last Name:BOXBERGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 JUNE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3759
Mailing Address - Country:US
Mailing Address - Phone:850-215-2896
Mailing Address - Fax:850-747-5326
Practice Address - Street 1:1515 JUNE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3759
Practice Address - Country:US
Practice Address - Phone:850-215-2896
Practice Address - Fax:850-747-5326
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108451363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical