Provider Demographics
NPI:1356693881
Name:LEE, WILLIAM DEWEY III (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEWEY
Last Name:LEE
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:DRAWER 657
Mailing Address - Street 2:P.O.BOX 850001
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0657
Mailing Address - Country:US
Mailing Address - Phone:904-565-1271
Mailing Address - Fax:904-645-7325
Practice Address - Street 1:12086 FORT CAROLINE RD
Practice Address - Street 2:STE # 401
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2687
Practice Address - Country:US
Practice Address - Phone:904-565-1271
Practice Address - Fax:904-646-1733
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2013-02-11
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106828363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical