Provider Demographics
NPI:1023019650
Name:LEE-EVENSON, DOROTHY T (MD)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:T
Last Name:LEE-EVENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:T
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:515 S KINGS AVE STE 3000
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6060
Practice Address - Country:US
Practice Address - Phone:813-681-6625
Practice Address - Fax:813-684-6043
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126018207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIK163ZOtherMEDICARE PTAN
FL016070200Medicaid
MT000082612Medicare ID - Type Unspecified