Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 25153 | FL |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MA03006100 | NJ |
NPI | 1013228543 |
---|---|
Provider Name | Dr. Connie C Lee |
First Address | Fort Myers, FL 33907-7531 |
Second Address | Fort Myers, FL 33907-7531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 08/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME25153 | MEDICAL LICENSE (01) | FL |