Provider Demographics
NPI:1588768634
Name:LUMPKIN, LEE R III (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:R
Last Name:LUMPKIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 COMMERCIAL COURT
Mailing Address - Street 2:SUITE E
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1651
Mailing Address - Country:US
Mailing Address - Phone:941-486-1404
Mailing Address - Fax:941-486-4146
Practice Address - Street 1:395 COMMERCIAL COURT
Practice Address - Street 2:SUITE E
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1651
Practice Address - Country:US
Practice Address - Phone:941-486-1404
Practice Address - Fax:941-486-4146
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 91379207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
K9656Medicare ID - Type Unspecified
B81834Medicare UPIN