Provider Demographics
NPI:1689677387
Name:LEE, HARRY W (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:W
Last Name:LEE
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 1:2856 NE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5818
Mailing Address - Country:US
Mailing Address - Phone:954-565-4810
Mailing Address - Fax:919-425-1596
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-714-6322
Practice Address - Fax:919-425-1596
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24378207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71804KMedicare ID - Type UnspecifiedBROWARD GENERAL
D58197Medicare UPIN
FL71804LMedicare PIN
FL71804NMedicare PIN
FL71804KMedicare PIN
FL71804MMedicare PIN