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Individual
RENE A LEE PACK
Active
Individual
RENE A LEE PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME57143
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11688
BLUE CROSS BLUE SHIELD
FL
01
—
218976
AVMED
FL
01
—
6467734
CIGNA
FL
01
—
E73090
VISTA HEALTHPLAN
FL
Enumeration date
04/26/2006
Last updated
07/11/2007
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