Provider Demographics
NPI:1548699424
Name:LEMOND, LEE JR
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:LEMOND
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 WAVA AVE
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1751
Mailing Address - Country:US
Mailing Address - Phone:850-737-1574
Mailing Address - Fax:850-897-4072
Practice Address - Street 1:285 WAVA AVE
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578
Practice Address - Country:US
Practice Address - Phone:850-737-1574
Practice Address - Fax:850-897-4072
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5857746216Medicare PIN