Provider Demographics
NPI:1780787689
Name:LEE, RICHARD THOMAS (CRNA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:THOMAS
Last Name:LEE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1381 CITRUS TOWER BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711
Mailing Address - Country:US
Mailing Address - Phone:352-243-9114
Mailing Address - Fax:352-243-7822
Practice Address - Street 1:1381 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-243-9114
Practice Address - Fax:352-243-7822
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1293162367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG0722OtherBCBS
FLR58239Medicare UPIN
FLG0722Medicare ID - Type Unspecified