Provider Demographics
NPI:1780674549
Name:LEE, ALFRED S (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5307 MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2536
Mailing Address - Country:US
Mailing Address - Phone:727-846-6900
Mailing Address - Fax:727-846-6910
Practice Address - Street 1:5307 MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2536
Practice Address - Country:US
Practice Address - Phone:727-846-6900
Practice Address - Fax:727-846-6910
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2014-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME78944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110195754OtherMEDICARE RAILROAD
FL47280OtherBLUE CROSS / BLUE SHIELD
FL257605800Medicaid
FLG72923Medicare UPIN
FL47280Medicare ID - Type Unspecified