Provider Demographics
NPI:1699022947
Name:LEE, MONICA R (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:R
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 11TH PL N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6829
Mailing Address - Country:US
Mailing Address - Phone:330-207-7689
Mailing Address - Fax:
Practice Address - Street 1:4321 N MACDILL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6388
Practice Address - Country:US
Practice Address - Phone:813-872-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101264084207V00000X
LA303016207V00000X
FLME142863207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2196588Medicaid
MS09179048Medicaid
LA2196588Medicaid