Provider Demographics
NPI:1700816196
Name:LEE, JEANIE O (DAOM)
Entity Type:Individual
Prefix:DR
First Name:JEANIE
Middle Name:O
Last Name:LEE
Suffix:
Gender:F
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 MEDICAL WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5548
Mailing Address - Country:US
Mailing Address - Phone:863-386-5050
Mailing Address - Fax:
Practice Address - Street 1:3101 MEDICAL WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5548
Practice Address - Country:US
Practice Address - Phone:863-386-5050
Practice Address - Fax:863-402-1090
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1783171100000X
RIDA00201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0890OtherBCBS OF FL