Organization
LEE D. ETTINGER, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIE BENOIT (MANAGER)
(850) 974-7120
Entity
Organization
Contact information
Practice address
914 MAR WALT DR # C, FORT WALTON BEACH, FL 32547
(850) 863-3199
(850) 863-3196
Mailing address
PO BOX 792, SHALIMAR, FL 32579-0792
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
ME35386
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067872400
—
FL
01
—
110007848
MEDICARE RAILROAD
FL
Enumeration date
02/12/2007
Last updated
08/20/2018
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