Individual
DR. JUSTIN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSC., MSC., M.D.,
Contact information
Practice address
1 GOOD SAMARITAN WAY, MOUNT VERNON, IL 62864-2402
(188) 993-8696
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036144067
IL
207Q00000X
Family Medicine Physician
51528
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/06/2009
Last updated
03/18/2019
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