Doctor Name: | SPENCER DARRELL LEE |
NPI Number: | 1053470252 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | ME 76643 |
Business Practice Address: | 525 Nw Lake Whitney Pl Suite 206 Port St Lucie, FL - 349861605 |
Business Phone Number: | 7728788885 |
Business Fax Number: | 7728785898 |
Mailing Address: | 525 Nw Lake Whitney Pl, Suite 206 PORT ST LUCIE |
State: | FL |
Postal Code: | 349861605 |
Phone Number: | 7728788885 |
Fax Number: | 7728785898 |
NPI Enumeration Date: | 12/06/2006 |
NPI Last Update Date: | 05/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | ME 76643 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |