Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101241301 | VA |
N | 2081S0010X | Sports Medicine | 0101241301 | VA |
N | 213ES0000X | Sports Medicine | 0101241301 | VA |
NPI | 1376732628 |
---|---|
Provider Name | Travis Lee |
First Address | Chesapeake, VA 23320-2635 |
Second Address | Chesapeake, VA 23320-2635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2007 |
Last Update Date | 31/05/2016 |