Provider Demographics
NPI:1265422141
Name:SAYNER, LEE RUSSELL (DPM)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:RUSSELL
Last Name:SAYNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620A N WOOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-9461
Mailing Address - Country:US
Mailing Address - Phone:330-364-7546
Mailing Address - Fax:330-364-3720
Practice Address - Street 1:2620A N WOOSTER AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9461
Practice Address - Country:US
Practice Address - Phone:330-364-7546
Practice Address - Fax:330-364-3720
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003372213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2502303Medicaid
OH2502303Medicaid
OHH304340Medicare PIN
OH2502303Medicaid