Individual
SUZY LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9411 FOUNTAIN MEDICAL CT, STE E100, BONITA SPRINGS, FL 34135-4625
(239) 221-8516
(239) 221-8787
Mailing address
9411 FOUNTAIN MEDICAL CT, STE E100, BONITA SPRINGS, FL 34135-4625
(239) 221-8516
(239) 221-8787
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME76644
FL
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
ME76644
FL
207NP0225X
Pediatric Dermatology Physician
ME76644
FL
207NS0135X
Procedural Dermatology Physician
ME76644
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002UE
BCBS GROUP
FL
01
—
44836
BCBS FL
FL
01
—
45-4144852
TAX ID
FL
01
—
DT0473
RAILROAD MEDICARE GROUP
FL
01
—
E1541Y
MEDICARE INDIVIDUAL
FL
01
—
FY111A
MEDICARE GROUP
FL
01
—
P01091011
RAILROAD MEDICARE INDIVIDUAL
FL
Enumeration date
06/22/2005
Last updated
01/16/2013
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