Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0S0005913 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | OS0005913 | FL |
NPI | 1023195112 |
---|---|
Provider Name | Kenneth Baruch Lee |
First Address | Ocala, FL 34477-0719 |
Second Address | Ocala, FL 34476-8623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 26/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
063885400 | (05) | FL |
80388 | BCBS (01) | FL |
E87656 | (02) | |
P0021885400 | RR MEDICARE (01) | FL |