Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME126018 | FL |
NPI | 1023019650 |
---|---|
Provider Name | Dorothy T Lee-Evenson |
First Address | Ocala, FL 34471-6543 |
Second Address | Ocala, FL 34471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2005 |
Last Update Date | 25/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016070200 | (05) | FL |
IK163Z | MEDICARE PTAN (01) | FL |